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TOTAL KNEE REPLACEMENT 101

Preparing for successful joint replacement surgery and recovery

About Total Knee Replacement 

Total knee replacement (TKR) stands as a cornerstone in modern medicine, renowned for its remarkable success in restoring mobility and enhancing quality of life. It’s hailed as one of the most triumphant surgeries, empowering individuals to reclaim an active lifestyle. Notably, TKR is pivotal in sustaining workplace productivity, particularly in an aging society like the United States.

At its core, TKR entails resurfacing the ends of the thigh and shin bones, while preserving crucial ligaments such as the posterior cruciate, medial, and lateral collateral ligaments. Although the anterior cruciate ligament may be removed, advancements in knee replacements ensure optimal function even without it.

Robotic Knee Surgery

Integrating computer software and GPS tracking technology has paved the way for robotic-assisted total knee replacement, a significant advancement in surgical precision. While the procedure’s fundamental principles remain unchanged, the utilization of these technologies enables surgeons to achieve more accurate placement and alignment of implants, mitigating potential human errors during surgery.

Early studies indicate that robotic-assisted total knee replacement yields comparable outcomes to traditional methods at the one-year mark post-operation. However, there’s a promising trend towards enhanced survivorship and improved functionality over time.

Overall, total knee replacement boasts exceptional outcomes, with over 95% of patients reporting significant pain relief and remarkable enhancements in daily activities. While complications are rare, estimated between 1% and 5%, they may include infection, joint stiffness, blood clots, or implant loosening.

What is Arthritis?

Arthritis is a general term for inflammation within a joint or area where two bones come together. Types of arthritis can include those related to wear and tear of cartilage, known as osteoarthritis, to those associated with an autoimmune disease, such as rheumatoid or psoriatic arthritis.

Although any joint can be compromised, the hip, knee, and shoulder are often more commonly affected by arthritis. 

It is not always certain why arthritis develops. Most physicians believe it is a combination of factors, such as muscle weakness, obesity, heredity, joint injury or stress, constant exposure to the cold, and aging.

joint replacement body models

PREPARING FOR SURGERY

  • Make a list of all current medications with correct dosages as well as time taken. You need to have this available for your preoperative appointment.
  • Be sure to obtain primary care physician clearance for surgery as well as all ordered preoperative laboratory studies as instructed by your surgeon.
  • If recommended, schedule prehab with physical therapy. This should be completed prior to proceeding with surgery.
  • We strongly encourage attending the pre-op Joint Class.

Medications prior to surgery

  • If you are diabetic do not take your diabetic medications after midnight on the day of surgery.
  • Aspirin, ibuprofen, naproxen, or any anti-inflammatories should be stopped 7 days prior to surgery.
  • Any blood thinners should be stopped based on your primary care physician’s recommendation.
  • The hospital or surgery center will also instruct you on which of your home medications you should take the morning of surgery.

1-2 Weeks Prior to Surgery

  • 1 week prior to surgery stop all anti-inflammatory medications such as aspirin, diclofenac, and ibuprofen. Tylenol is OK to take.
  • Be sure to have a scheduled preoperative appointment within 1 to 2 weeks prior to surgery. Please be sure you have reviewed this entire packet but if you have questions, please write them down before and as you think of them.
  • You must notify the physician if you or any of your family members have a history of previous DVT or blood clot. Blood clot prevention medications are always used (typically Aspirin) but these would need to be changed if there is a significant personal or family history of blood clots.

Day before surgery

  • You will receive a call from the hospital (1-2 days prior to surgery) with instructions on arrival time.
  • Bring your own loose-fitting, comfortable clothing.
  • Nothing to eat or drink after midnight.
  • Be sure to bring a list of medications, including dosages and instructions, the to surgery.
  • Bring this packet with you to have with you for your surgery.
  • If you have sleep apnea and use a CPAP machine, bring that with you.
  • Be sure to perform antibacterial (Hibiclens/ Chlorhexidine) cleansing the night before and morning of your surgery.

Day of Surgery

  • After you have been checked in an IV will be placed.
  • You will be given IV antibiotics within 60 minutes of your surgery to decrease risk of infection.
  • You will meet with the anesthesiologist to discuss their role in surgery. Typically, a spinal anesthetic is used and is preferable, but occasionally a general anesthetic will be needed.  They will also discuss with you a nerve block.  This is highly recommended as it will significantly decrease pain after surgery.
  • Surgery time is between 60 and 90 minutes.
  • After surgery, you will be in the recovery room for approximately 45 minutes to an hour.
  • After recovery, the orthopedic nurses and therapists will work with you. You typically will begin physical therapy within a couple hours of your surgery.
  • You will resume your regular diet.
  • There are minimal restrictions after surgery. Activities are typically limited by pain.
  • The orthopedic nurses will monitor you. They will help to ensure that you are doing your deep breathing exercises and able to urinate, periodically check your vitals, assist you in and out of bed, and help with physical therapy.
  • Once you have achieved the physical therapy goals and are medically stable, you can be discharged if you wish.
  • If surgery is done at the surgery center you will be discharged within 4 hours after your surgery.

Controlling Pain After Joint Replacement

Our goal at Sano is to help you control your pain and reduce it over time, but you can expect some pain immediately and in the weeks following surgery.

There are various ways to help reduce pain after surgery that is simple to do and don’t involve the use of narcotics.

  • Physical Therapy
  • Ice
  • Heat
  • Adjusting your sleeping position
  • Resting – do not overdo it or return to certain activities too soon
  • Medications

After Surgery Care

First Day after surgery

Your incision site is about 4-6 inches long. Generally, your sutures will be under the skin, and the incision will be covered with glue and a dry dressing.

  • If still in the hospital, you will receive physical therapy in the morning and likely be discharged late morning or early afternoon.
  • Upon discharge:
    • You will receive aspirin or another blood thinner to decrease risk of clots. This will be discussed before surgery.
    • You will go home with pain medication.
    • You may be given an anti-inflammatory or a short course of prednisone.
    • You may be given a muscle relaxer.
    • Please take medications as instructed.
  • Make every effort to stay mobile.
  • On the second or third day after surgery, you can remove the Ace wrap and padded dressing. Leave the incisional dressing in place.  It is okay to shower with the incisional dressing in place.  Keep the battery pack dry.

First 2 weeks after surgery

  • You will have a dressing over your incision that should be removed in 5 to 7 days. Following this it is okay to get the incision wet and cover with a light dressing.  Do not soak the incision (tub etc.).  Do not use ointments on the incision.
  • To remove dressing:
    • Turn off the pump before removing the dressing by holding the off button for 5 seconds. Suction must be turned off before dressing is removed. When ready to remove the dressing, gently pull on the sides of the dressing to loosen. To remove dressing, pull in the direction of the incision.
  • Outpatient physical therapy is preferred. This should start within 3 days of surgery.
  • If home health care physical therapy is ordered this should not last more than 14 days before transitioning to outpatient physical therapy.
  • Inpatient rehab is discouraged but is sometimes necessary in select cases. Please know patient’s going to rehab facilities have more than double the risk of ER visit readmission to hospital.  There is also a risk of community acquired respiratory infections.
  • You may participate in activities as pain allows.
  • Sleeping is often difficult the first few weeks after surgery. This can be typical.  Icing can help.  Over-the-counter sleep aids can be used if needed.
  • Fever around 100 degrees within the first week is typical and not an indication of infection.
  • It is expected to have difficulty with bowel movements, use of mild stool softener can be helpful.
  • Leg swelling and some bruising is typical after knee replacement.
  • Patchy numbness is common around the incision.

2 - 6 weeks after surgery

  • It is common to be sore and stiff after sitting or at the end of the day.
  • Sleeping may continue to be difficult. You may use over-the-counter sleep aids if needed.
  • You should be requiring less pain medication as time goes by. Pain medications will be given as needed up to 8 weeks post op.  It is important to transition to over-the-counter anti-inflammatories or tylenol.
  • Continue fully participating in physical therapy and a home exercise program directed by your therapist. You will be in therapy for up to 12 weeks after surgery.
  • Small bumps on your incision may appear around 4 to 6 weeks. These are common and known as small suture abscesses.  These happen because the absorbable sutures are being absorbed by the body and create a foreign body type reaction that may surface on the skin.  These are not typically concerned for deep infection.
  • When to contact your surgeon:
    • Continued drainage from the wound.
    • Redness that increases.
    • Shortness of breath or chest pain
    • Fever of 102 or higher
    • Dramatic new onset leg swelling

12 Months after surgery

  • Typically, less pain and stiffness, however mild stiffness may be present.
  • You may still have soreness at the end of the day.
  • Swelling should be minimal.
  • Increase activity as tolerated.
  • Please note that the warmth of your knee may persist for up to 6 months. This can be typical.
  • You will have an appointment with your surgeon’s team 1 year after surgery.
joint replacement body models

CAUTION!

Signs of possible blood clot:

  • Increasing pain in the calf of your surgical leg
  • Tenderness and increasing swelling in your calf, ankle, and foot
  • Sudden redness in your calf

Please call the office or 911 immediately if you experience:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Signs and symptoms of infection:

  • Thick, white, or greenish drainage coming from the incision site
  • Foul smelling drainage
  • Increasing redness, tenderness, or swelling of the incision
  • A persistent fever of 100 degrees orally or higher
  • Increased pain with both activity and rest

Please get in touch with the office immediately if you are experiencing any of these signs or symptoms.

DRIVING & DENTIST QUESTIONS

DRIVING AFTER SURGERY

You will need someone to drive you home after surgery. Please prepare a family member or friend to do so. After your surgery, we do not want you to drive while taking narcotic pain medications (i.e. oxycodone, hydrocodone). Generally, after a left knee or hip total joint replacement, we do not want you to drive for at least 2 weeks after surgery. After a right knee or hip total joint replacement, we do not want you to drive for at least 6 weeks after surgery. After a shoulder replacement, we do not want you to drive while in a sling, which can be up to 6 weeks after surgery. Please make arrangements for post-operative appointments and physical therapy appointments.

DENTAL CLEANINGS/EXAMS

We recommend avoiding any dental appointments for the first 3 months following surgery unless an emergency arises.  We do not recommend antibiotics for routine exams and cleanings.  Antibiotics should be given for other types of dental procedures.  Please notify our office so that we can send in appropriate antibiotics and instructions.

Frequently Asked Questions about Joint Replacement

What is the best way to communicate with my doctor?

We offer a secure text platform: 816-551-2339. Questions, pictures, and medication requests can all be sent via text. Please allow 24 hours for a response. 

What time will my surgery be?

The hospital or surgery center will set your surgery time. They will contact you 1-2 business days before your surgery.  Any questions or concerns regarding the time of your surgery should be directed to the facility.

What if I have a metal allergy?

If you are allergic or sensitive to metal, then it is important to alert your surgeon before having joint replacement surgery. The most common metal allergy is nickel, which is found in very small quantities in knee implants and some hip implants. While up to 14% of people will have some reaction to certain metal allergy tests, metal allergy is a very rare cause of failure of new replacement.  

Wound care:

Most incisions will be closed with dissolving sutures and will have nothing outside of the skin.  Occasionally, staples will be used.  Once the surgical suction dressing is removed 5 to 7 days after surgery, it is okay to get the incision wet and cleaned with a mild soap and water.  No soaking of the incision.  No ointments, rubbing alcohol, or hydrogen peroxide should be used on the incision.  Soaking of the incision, such as swimming or bathtub, is permitted after 4 weeks.

Will I need TED hose after surgery?

Yes, we recommend always wearing TED hose on the surgical extremity except hygiene for the first 4 weeks following surgery.  These help to decrease swelling and may decrease risk of blood clots.

Motion machine after knee surgery?

Studies have shown that the motion machine does not improve motion or function following her surgery. In many cases, patients feel that this is a replacement for physical therapy. We, therefore, do not currently recommend the use of these machines.

How will my incision look?

It is typical to have warmth, swelling, bruising, and redness around your incision. A small amount of drainage is typical.  If you are having continued drainage, please notify our office.

How will my knee feel after surgery?

You may notice some locking or clicking.  This is very normal with knee replacement and is typically not a concern.  You may also feel stiffness and tightness in the knee for the first several months.

Can I kneel on my knee replacement?

Yes, that is okay to kneel as tolerated.  Most patients do have some difficulty due to tenderness or awkward feeling when attempting to kneel.  This typically improves over time.

Will I have difficulty sleeping after surgery?

Most patients will experience some difficulty sleeping following surgery.  This can be typical the first few months.  Over-the-counter sleep aids can be used.  We do not typically recommend prescribing sleeping pills.

How long do I take pain medications?

Pain medications may be needed up to 8 weeks post op.  Please allow 2 days for refills.  

How often will I follow-up with my surgeon?

The first visit is typically 2 weeks after surgery.  Then, 6 weeks after surgery, followed by 3 months after surgery, and final visit is at 1 year post op.

FMLA and short-term disability paperwork

Drop off or text us your forms. The form can be submitted before surgery but will not be completed until after surgery. Once payment is received and the release form is completed, the paperwork will be completed 7 – 10 business days after surgery.

If your employer needs something prior to the date of surgery, a letter can be provided.

How can I travel or fly with my joint replacement?

When traveling, especially the first 12 weeks after surgery, we ask that you take frequent breaks every 2-3 hours to stand up and walk around. We would encourage you to take an anticoagulation medication during the travel portion of your trip. You will also set off metal detectors. Notify the personnel that you have a joint replacement.

A word about health insurance.

It is your responsibility to provide current accurate insurance information.  This allows for a more seamless prior authorization process if it is required.  Your insurance company will process the claim according to your specific plan based on your benefits.  Our surgical team does not control your insurance company’s processes or benefits.  Increasing numbers of denials for surgical claims may require further pre-op treatment to gain insurance approval.  

How should I prepare my home?

Cleaning your home prior to surgery is helpful. Tack down any loose carpeting, electrical cords, or any trip hazards. You may want to obtain a shower chair or a toilet seat riser. We also suggest obtaining “Press and Seal” or clingwrap prior to surgery to help keep the incision site dry after surgery. 

Questions?

Regenerative medicine is an emerging area with ongoing research.  As such, regenerative treatments are still considered investigational and are not covered by insurance.  PRP and BMAC are not recommended for all patients or conditions. Set up an appointment with our Regenerative Medicine specialist to see if regenerative medicine may be right for you.

 

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