Understanding Total Knee Replacement: Preparation, Surgery and Recovery

Sometimes a knee replacement is the only option for reducing pain and restoring a normal activity level. If Taos Orthopaedic Institute and you decide that knee surgery is right for you, here is an idea of what to expect during days leading up to, the day of, and the days after your surgery.

Preparing For Your Operation

1. Betadine (iodine) showers are advised twice daily for two weeks before surgery to lower the bacteria count of the skin. You can obtain Betadine Skin Cleanser from most pharmacies without a prescription.

2. Multiple vitamins are advised, one daily for two weeks before surgery.

3. Discontinue aspirin and anti-inflammatory drugs (arthritis medications) two weeks before surgery.

4. There is a program known as auto transfusion for those who are able to give their own blood. Your blood will be held for your own use and returned at the time of surgery. Arrangements for this procedure can be made with our office.

Additionally, patients participating in this program need to take supplemental iron tablets as well as a multivitamin.

5. A dentist must check your teeth for any abscess or infection prior to surgery.

6. A complete medical evaluation must be performed prior to surgery by your primary care physician. You will also obtain the necessary preoperative studies such as a chest x-ray, blood counts and electrocardiogram.

The Day of Surgery

1. Absolutely nothing should be taken by mouth to eat or drink after midnight on the night before surgery. It is essential that your stomach be completely empty at the time of your operation.

2. Your knee will be shaved and scrubbed by an OR nurse prior to the operation to ensure cleanliness.

3. Antibiotic medications will be started just prior to surgery and continued after the operation intravenously.

4. You will be taken to the operating room approximately twenty minutes before the scheduled time of your surgery. You will be asked to wear a hospital gown and to remove any jewelry as well as dentures or wigs. Your valuables should be left at home or with your family. If this is not possible, please leave them with the nursing staff who will arrange security.

5. You will receive preoperative medications by injection to help you relax and be more comfortable during preparations for your surgery.

6. You will be transported to the operating room on a stretcher or bed. There you will be given medication by the Anesthetist to put you to sleep once you are in the room. There are a wide variety of techniques used for anesthesia, all of which prevent pain during the surgical procedure. If you wish, it is even possible to be awake during your surgery.

AFTER SURGERY

1. You will be in the recovery room in your bed with your knee cushioned in a Continuous Passive Motion (C.P.M.) machine. This cradle will help you with your physical therapy by slowly increasing the motion of your knee throughout your hospital stay.

2. Intravenous fluids and antibiotics are often given for the first two post-operative days. You may eat and drink as you are able to tolerate liquids and food.

3. The nurses and physical therapist will show you how to move in bed and how to exercise your legs.

4. Several measures are taken to prevent blood clots. Elastic stockings and foot compression pumps are worn and calf exercises are encouraged. A special medication will be administered to help prevent blood clots from forming. Early ambulation, mobilization and physical therapy (post-surgical Day #1) are also important to improve circulation and to prevent complications.

5. The surgical dressing is removed two days after surgery. There may be small drainage tubes that are usually removed two days after surgery.

6. Exercises to strengthen the arms and legs and to encourage circulation are performed throughout the entire postoperative period.

7. Pain control is achieved by a variety of effective measures including pills, injections, PCA (patient controlled analgesia), and epidural analgesia. PCA is given via an IV into the arm, and pain relief can be achieved by pressing a button to administer your own medication. In addition, pain and sleeping medications are available and can be obtained simply by asking or notifying the nursing staff. If the drug prescribed does not appear satisfactory, please notify the nursing or medical staff so that a substitute may be ordered.

8. Ambulation with a walker is started on the first postoperative day. The physical therapist will help with walking and bending the knee twice a day. Walking is performed with the assistance of the physical therapist and by the Nursing Staff. Your family can also assist you when you are strong enough.

Preparation for Leaving the Hospital

Goals

The hospital time is primarily devoted to increasing your level of independence and bending your knee. We prescribe daily physical therapy sessions to increase range of motion of your knee. Stair climbing may be instructed as well as the basic activities of daily living.

Prior to being discharged from the hospital, you must be able to:

1. Get in and out of bed yourself.

2. Walk confidently in the hallway with a walker or crutches.

3. Climb stairs.

4. Be able to bathe and care for yourself.

5. Understand all the dos and don’ts for being at home.

6. You also must be able to bend your knee an acceptable amount.

If you are unable to achieve these goals in the hospital, these tasks can be accomplished by transferring you for additional treatment at an Inpatient Rehabilitation Center or in a Skilled Nursing Facility prior to your discharge to home.

When you go home, outpatient or home physical therapy services will be arranged. In special cases, a home nursing or health aide may be recommended. You may need someone to provide food and run errands. Our Social Service Department will help you with the details of these arrangements. Please ask our team (nurses, doctors, physical therapists, social service department, etc.) to help you to make these decisions.