TOTAL KNEE REPLACEMENT
INTRODUCTION
These instructions were designed to provide you with information about your upcoming knee replacement. It contains important instructions for you to follow before the surgery, after the surgery while in the hospital, and after the surgery while at home.
Knee replacement surgery requires the participation of the patient as well as the medical team. To ensure a long-lasting successful result, all the guidelines reviewed in this booklet need to be followed.
The joint replacement program at Kaiser Permanente has been carefully developed in the sincere hope that your new prosthetic joint will offer you long-lasting pain relief and improved mobility. By the time you return home, you will be familiar with precautions and exercises which protect your new knee and encourage stability and healing. Your surgeon, physical therapists, and nurses will instruct and assist you in learning these precautions and exercises.
SPECIAL INFORMATION
Joint replacements can become infected at any time after the surgery – from the first postoperative day to many years down the line. You can take the following steps to help prevent infection:
Take antibiotics before dental procedures – see information on the back of
your wallet card.
See your primary doctor right away for any suspected urinary tract infections.
Look for signs of infection in the knee including increasing pain, redness,
or swelling.
After surgery, if you have any instances of shortness of breath, chest pain, upper back pain or any hot, red spots anywhere on your leg, please seek medical attention immediately.
Your new joint replacement may trigger airport metal detectors. We will give you a card that verifies that you have had a knee replacement.
Keep in mind that your new knee replacement is a mechanical device. While normal walking is never a problem, running or jumping puts an abnormal amount of stress on the knee replacement and can cause loosening.
BEFORE SURGERY
Stop all aspirin and/or anti-inflammatory medications like Motrin, Advil, Indocin, Feldene, Naprosyn, Vioxx, Celebrex, Salsalate, Relafen, and Clinoril two weeks before surgery. Use Tylenol as your only pain medication.
If you are taking any blood thinners like Coumadin or Plavix or Persantine, speak to your medical doctor about their use before surgery. These medications are usually stopped one to two weeks prior to surgery.
Continue to take all of your regular medications like pills for your high blood pressure, your heart, or your diabetes.
Take a shower the morning of surgery.
Report any serious upper respiratory illness or any infection (urinary and tooth especially) to your doctor if they are present in the two weeks prior to surgery.
Be sure to arrange for added assistance at home when you are discharged from the hospital.
Donate one of blood to the Blood Bank if your doctor feels you are medically able to do this.
Do not drink or eat anything after midnight the night before surgery. Your surgeon or anesthesiologist may instruct you to take some of your regular medications with a sip of water on the morning of surgery.
Remove the following: makeup, nail polish, hairpins, jewelry (wedding rings may be taped to the finger), hairpieces. Eyeglasses, contact lenses, and hearing aids will have to be removed just prior to surgery.
You will be admitted to the hospital on the day of surgery. Your clothes and toiletries you pack will be kept for you by the hospital staff. Please leave any valuables with a relative or friend.
AFTER SURGERY
You will be mostly in bed for the first 24 hours. You will be out of bed and into a chair on the first day after surgery.
There will be tubes in the knee that drain excess blood.
There will probably be a catheter in your bladder.
You may require a blood transfusion. Your own blood will be given if you have donated some.
Medications to expect:
- The regular medications you took prior to surgery, except for
anti-inflammatory medications
b. A blood thinner.
- Intravenous antibiotics for the first 48 hours.
- Pain medication – Usually given through an epidural (back) catheter, or by Patient Controlled Analgesia Pump, or by mouth.
Blood samples will be drawn from you daily so your surgeon can determine if you need a blood transfusion or any adjustment in your medications.
Use the special breathing machine and breathing exercise to clear your lungs to prevent pneumonia. The most common cause of a fever in the first few days after surgery is atelectasis or partially collapsed lungs from anesthesia and lack of activity.
Wear compression stockings at all times. You may also be asked to wear special pneumatic boots that constantly squeeze your calves to pump blood towards your heart. These help prevent blood clots.
Do bedside exercises as directed by the physical therapist.
Physical therapy will start early in your hospital stay. When you have satisfactorily met the goals of therapy as defined by your doctor, you will be able to go home.
You will need to use a walker, crutches, or a cane for approximately six weeks.
HOME EXERCISES AFTER TOTAL KNEE REPLACEMENTDO EACH EXERCISE TWICE A DAY
These exercises may cause some discomfort. If pain increases with exercise, discontinue the exercises and contact your surgeon or physical therapist.
AT HOME AFTER SURGERY
Follow all instructions of the physical therapist. You will be given information concerning exercises and precautions. The home therapist will see you 2-3 times a week or as necessary for the first month. After the first month, if the therapist feels it is necessary, you will come into the medical center for your physical therapy. Many patients do not need physical therapy after the first month.
No shower or bath for two weeks; sponge bathe only; keep the dressing dry.
Do not drive for six weeks.
Do not plan airplane travel for approximately two months.
Do not have a dental cleaning for 3-6 months after surgery. You will need to take antibiotics for any dental treatments.
You may walk unlimited distances following the weight-bearing instructions given by your surgeon.
You will be given a prescription for pain pills to take by mouth as needed. Call the office nurse for refills before you are out of pills.
Wear the compression stockings for one month after surgery. The stockings should not pinch or constrict any part of your leg
At two weeks the Home Health Nurse or Physical Therapist will remove staples or sutures. You may shower 24 hours after those are removed.
Coumadin: A blood thinner you will take for three weeks after surgery. A home health person will take blood samples 2-3 times weekly while you are on Coumadin. Do not take any aspirin or anti-inflammatory drug while on Coumadin.
Iron/Vitamins: Continue iron tablets for one month after surgery. Continue multivitamins indefinitely.
Bowel Movements may be difficult while you are taking iron or pain medication. Be sure to take the stool softener regularly. To avoid constipation, drink lots of fluids: water, juices, herbal teas. Avoid ginseng and ginkgo while on Coumadin.
Diet: Protein is important. Even if your appetite is poor, try to eat small, nutritious meals frequently. Avoid heavy fats or “fast foods.”
IMPORTANT DATES:
Blood Donation: First Unit______
Second Unit______
Third Unit (only if requested) ______
Preoperative appointment with your surgeon:______
Preoperative appointment with your medical doctor:______
Date of surgery:______
Time of arrival at hospital:______
First office visit:______
ROUTINE OFFICE VISITS AFTER SURGERY
An x-ray will be done at each visit.
Four weeks
Three months
Six months
One year
Two years
Five years, then every five years or sooner if you have pain