GUIDELINES FOR PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT

This information is designed to be a general guide to you. It must be emphasized, however, that EACH PATIENT is unique and will be treated individually according to his or her needs.

PREOPERATIVE PREPARATION
• Clearance
   o You will be asked to see your primary care provider who will determine if you are safe to undergo surgery.
   o You may be asked to see another specialist(s) based on your medical history.
• Pre-Admission Testing
   o Laboratory studies, urinalysis and nasal swab testing for MRSA
   o Chest xray
   o EKG
• You will need to stop taking anti-inflammatories (Aspirin, Ibuprofen, Advil, Motrin, Aleve, Celebrex, Mobic, Voltaren, etc) 1 week prior to surgery. If Aspirin has been prescribed to you by another provider, please contact them to be sure it is safe to stop this. You will also need to stop prescription blood thinners – we will ask your prescribing physician to recommend what is safe for you.
• If you smoke, we strongly advise that you try to stop smoking prior to surgery. Smoking increases the chance of post-operative lung complications and also affects healing.
• If you become ill or have a fever prior to surgery, please notify your PCP. This could affect whether or not it is safe to do your surgery.

THE DAY OF ADMISSION AND SURGERY
• You may have nothing to eat after midnight prior to your surgery. You may have clear liquids (water, black coffee) up to 2 hours prior to surgery. You may take cardiac, diabetic, thyroid, hypertension and/or seizure medications with a small sip of water the morning of surgery.
• Please arrive at your scheduled time.
• The anesthesiologist will see you prior to surgery.
• You will be prepped for surgery which may include pre-operative scrub and/or shave.
• An IV will be started for antibiotics, fluids and anesthesia.
• Before surgery, you will be asked to remove jewelry, dentures, contacts, wigs, etc. DO NOT BRING VALUABLES TO THE HOSPITAL.
• Anesthesia types may vary based on your medical history. Types of anesthesia used are general (asleep), spinal (numb from waist down), and/or a nerve block.
• A urinary catheter may be placed prior to surgery.
• Your surgery will take about an hour. Anesthesia before and after the procedure adds to the OR time. Your surgeon may have an assistant helping with your surgery.

IMMEDIATELY AFTER YOUR SURGERY
• After surgery, you will be moved to the recovery room until you are awake and alert. There will be a bandage on your knee.
• Once stable, you will be taken to your in-patient room.

THE DAYS FOLLOWING YOUR SURGERY
• Your blood count (hemoglobin) will be monitored to determine if a blood transfusion is necessary. In most cases it isn’t.
• A blood thinner will be started to prevent blood clots. The blood thinner selected will vary based on your medical history. The standard length of time the blood thinner is needed is 4 weeks – however, this is different in some cases. Ankle pumps will also be applied to maintain the flow of blood.
• You will be asked to deep breathe and cough after your surgery to prevent post-operative pulmonary complications.
• Pain medications will be ordered for you. It is important to take pain medications as scheduled in the first several days after surgery. These can be tapered once you are comfortable.
• Your IV will remain in place until you are tolerating a normal diet, do not require IV pain medications and have a stable blood count.
• Physical therapy will start on the day after surgery. In some cases, it may start on the day of surgery.
• Most people are discharged from the hospital in 2-3 days. This is determined by your surgeon, medical consultant and physical therapist.
• Your adhesive dressing should stay in place until your post-operative appointment. It is ok to shower if the dressing is sealed.
• You will have a post-operative appointment about 2 weeks after surgery. At this time, we will obtain an xray to check the components. We will also remove your staples.

Total Knee

IMPORTANT THINGS TO NOTE
• You may have numbness around your knee. This improves over time. Sometimes the feeling doesn’t completely return, but you will always have protective sensation (you will be able to feel sharp/heat).
• Your implant may make noise because it is a mechanical device. In most cases, this is nothing to worry about.
• Swelling and warmth may be present for several months while you are healing.
• Your altered gait after surgery may cause pain elsewhere – sciatic nerve irritation, low back pain, ankle pain, etc – this usually improves as you recover.
• You will be back to almost all normal activities in the first few weeks/months. However, full recovery can take 1-2 years.