Notes Total Knee Replacement A total knee replacement is a surgical procedure that replaces your knee with an artificial joint. The team at Poudre Valley Hospital provides joint replacement services of the highest quality and we want you to be an active participant on the team. That s why we re providing you with this booklet, which explains how to prepare for your surgery, what happens during the operation and your hospital stay, as well as what to expect as you recover. The knee is a complex, hinged joint that allows you to squat, kneel, sit, bend and straighten your leg. Three bony parts make up the knee: the shin bone (tibia), the thigh bone (femur), and the knee cap (patella). A total knee replacement is a surgical procedure that replaces your knee with an artificial joint (prosthesis). You can only walk easily and without pain when the bones are smooth and cushioned by healthy cartilage. Fluid in the joint helps lubricate the cartilage. Strong muscles and ligaments are also needed for joint stability. Conditions such as arthritis, old fractures, abnormal stress, and aging may damage the joint and cause rough areas to develop. This creates pain and stiffness when moving the knee. This could even result in the knee giving out during normal activities. A total knee replacement is an effective way to relieve the pain and restore movement in damaged knees. The replacement involves resurfacing the bones of the knee joint. There are three bony surfaces that can become rough and painful: the femur, tibia, and patella (knee cap). Depending on your condition, one, two, or all three of these surfaces may be replaced. The type of surgery you have depends on your age, the amount of damage to your knee, and your medical history. This surgery improves mobility and function, but does not guarantee a normal healthy knee. Healthy Knee Joint Diseased Knee Joint Artificial Knee (Prosthesis) Area of Bone Removed Patellar Component Femoral Component Femur Patella Tibial Component Articular Cartilage Fibula Tibia 12 Total Knee Replacement Total Knee Replacement 1
Getting Ready for Surgery Poudre Valley Hospital has classes available that you can take before your surgery to help you prepare for the operation and your recovery. Ask your nurse about the class schedule, or call PVH s Regional Orthopedic Center, 970.495.8260. An appointment is scheduled with a PVH preadmission nurse before the procedure. You are asked questions about your medical history and allergies. Bring a list of all medicines you currently take so the nurse can review them with you. This list should include the name of the medications (indicated if the prescription is written with an EX- ER or SR), the dose that you take and how many times a day you take that medication. This should also include all vitamins, herbs, supplements and over-the-counter medication you take routinely. Your doctor may order: Visits with other doctors. Blood and urine tests. X-rays. Electrocardiogram (EKG). Completion of any needed dental work at least one month prior to surgery. Notes Medications List all medications you are taking (include prescription, over-the-counter, herbal or natural products, vitamins, and drugs you take as needed, such as Tylenol). Include the name, dosage and when you take each medication. Cross off any medications your doctor has told you to stop taking. We prefer if you leave your medications at home, but if you bring them, they must be in their prescription bottle. Supplements must be in new, unopened bottles. Medication: Dose: Directions (when and how often you take it): Doctor name: Reason for taking: Correct Benacar Hct 20/12.5 by mouth daily Incorrect Benacar Hct 20 by mouth daily Correct Albuterol 0.083% 2 puffs every 4-6 hours as needed Incorrect Albuterol 2 puffs by mouth daily Correct Vitamin C 500 mg by mouth daily Incorrect Vitamin C 1 by mouth daily 2 Total Knee Replacement Total Knee Replacement 11
Home Equipment At home, you may need the following equipment: Walker (most common device after surgery) Tub transfer bench Toilet riser/commode chair Grab bars in bathroom and/or in shower The RN case manager discusses equipment needs with you and helps make arrangements to get the necessary items. Information is provided on local loan closets, equipment companies, and insurance coverage for medical equipment. Many people borrow equipment from friends or family. Home Safety You can make your recovery safer by becoming aware of hazards in the home. We offer the following home safety tips: Move electrical cords out of the way. Remove throw rugs. Add firm pillows to low chairs. Store items within easy reach. Watch for small pets or objects on the floor. Installing rails along stairs can be helpful. To avoid injuring yourself, always think before you move. Your doctor will let you know when you can resume driving. CALL YOUR DOCTOR IF YOU HAVE ANY OF THESE SYMPTOMS: Temperature greater than 101 degrees Shortness of breath or chest pain. Redness, swelling, or warmth at the incision Foul-smelling drainage from incision. Trouble maintaining knee motion. Extreme pain. Sudden muscle weakness, numbness, or tingling. Swelling, pain, or redness in lower leg, or sharp pain when you pull foot toward your head. Remember to wear elastic stockings as directed by your doctor. Before having a dental procedure, ask your doctor about taking antibiotics. Exercises before your surgery These exercises will help prepare you for a successful surgery. We recommend that you do 10 repetitions of each exercise, three times per day prior to surgery. If any exercise is painful, please stop. CHAIR PUSH-UPS Sit straight in a chair with your hands on the armrests. Straighten your arms and raise your bottom off the chair. Slowly lower yourself back to the chair. QUAD SETS Lie flat on your back. Tighten the quadricep muscles above your knee by pushing the back of your knee down toward the bed. Hold for a count of five. Relax. Repeat. You will be given a different exercise program after surgery. Your physical therapist will give you specific instructions on the exercises your surgeon wants you to perform. Helpful Tips You may wear your eyeglasses (no contact lenses) on the day of surgery. Please bring a case for them. You will be asked to remove your glasses before surgery. Bring loose-fitting pants or shorts and walking shoes with low heels. You may bring personal hygiene items (hairbrush, toothbrush, toothpaste, etc.). If you use a CPAP or BiPap, please bring it to the hospital with you. If you have advanced directives, please bring them. Do not bring jewelry, money, or other valuables to the hospital. Do not wear eye makeup or lipstick the day of surgery. Do not bring tobacco products. The Day of Surgery When you arrive at the hospital, you are escorted to the surgery area to prepare for the operation. One or two family members may come with you. Your knee is scrubbed with a special soap. An IV is started in your arm. Fluid and medicines are given through the IV. The doctor who gives you anesthesia visits and answers any questions. Medicine is given to help you relax. You may feel hot, dizzy, or drowsy. This is normal. After you go to sleep, your dentures and eyeglasses are removed. Operating rooms are cool. Heated blankets are provided for your comfort. 10 Total Knee Replacement Total Knee Replacement 3
Who Provides Your Care The orthopedic team works together to assist you during your hospital stay. We ll all work together to make sure you know what to expect as you recover. It s a joint effort and your complete satisfaction is our priority. PATIENT AND FAMILY You, your spouse, family or significant other are the most essential members of this team. Learning about your health and your surgery helps with your recovery. ORTHOPEDIC SURGEON In addition to planning and performing your surgery, your surgeon will work with the other team members to assure your complete and rapid recovery. Feel free to discuss any aspects of your care with your surgeon. NURSES Your nurse will monitor your condition throughout your stay. Your nurse can: Provide information and treatments needed for your recovery. Organize and coordinate your care. Work with you to manage your pain. Answers any questions or concerns. RN CASE MANAGER Your case manager helps you plan for your release from the hospital. This person can assist or answer questions about: Insurance coverage. Who can help you at home after you are discharged from the hospital. Discharge options, including home with family assistance, outpatient rehabilitation, home health care, skilled nursing facility or acute rehabilitation facility. Equipment needs. Temporary disabled parking permits. Referrals to other community resources. PHYSICAL THERAPISTS (PT) Your physical therapist focuses on your ability to get around and on helping you recover function in your knee. Your physical therapist can: Evaluate your mobility and strength. Teach you how to get out of bed, walk, climb stairs and get in and out of the car. Teach you how to walk with a walker or other devices. Give you exercises to increase your strength and improve your knee s range of motion. OCCUPATIONAL THERAPISTS (OT) You may be seen by an occupational therapist depending on the type of surgery you have and your doctor s orders. An occupational therapist can: Provide training to maximize your independence in activities of daily living. Evaluate your physical capabilities and limitations in order to determine your needs for equipment. Teach you how to use equipment such as a raised toilet seat, tub transfer bench, and a reacher and/or sock aid effectively. Provide guidelines for home safety. Planning Your Discharge The RN case manager meets with you to plan your discharge. Most patients will be discharged to their home with family assistance. We recommend that you plan ahead so that assistance is available when you leave the hospital. Safety issues, equipment, and the physical layout of your home are discussed. Suggestions are made to make your recovery easier and safer. Several discharge options are reviewed. Your final decision takes into account your doctor s recommendations, your individual needs, ability to tolerate physical activity, and insurance coverage. OUTPATIENT REHAB Outpatient physical therapy is the most typical continuation of rehabilitation after you leave the hospital. The orthopedic doctor will give you a referral to see an outpatient therapist. Your treatment plan will be determined by you and your outpatient therapist. ACUTE REHABILITATION CENTER This setting offers the most intense level of rehabilitation. The staff work with you to restore strength, knee motion, and skills needed to resume everyday activities. Physical, occupational, and other therapies are part of your daily routine. You must be able to participate in a minimum of 3 hours of therapy most days of the week Patients must have medical complexities requiring frequent rehab physician monitoring Patients must benefit from 24-hour rehab nursing care The goal for discharge should typically be home or independent living. You may be referred for home or outpatient therapy services after you go home. SKILLED NURSING: SUBACUTE CENTER A subacute center is usually located in a skilled nursing facility or long-term-care facility. It provides ongoing nursing care and rehab therapies that you need to complete your recovery. Nursing care is provided 24 hours a day encouraging patient independence. Physical and occupational therapy are available. This environment offers flexibility in establishing a therapy schedule according to your tolerance. The RN case manager arranges for any special equipment and/or further therapy you may need at discharge. HOME HEALTH CARE Home health care may be ordered for those patients who are homebound. (Some insurance companies specify which home health agency must be used.) The doctor writes orders specifying what home health services are required. The RN case manager discusses preferences and makes appropriate referrals. The goal of home health care is to help you reach a level of independence so you can go to outpatient rehabilitation sessions. 4 Total Knee Replacement Total Knee Replacement 9
Recovery and Rehabilitation As you begin your therapy program, you may feel weak or dizzy at first. This is normal. There may be some pain when you first start to move. Let your therapist know if the pain is too severe. The doctor decides how much weight you can put on your operated leg. It is important to follow these restrictions to allow proper healing of your new knee. All patients get up to a chair for meals with assistance from staff. SURGERY DAY Nurses will check on you frequently and take your vital signs often. You need to ask your nurse for pain medication when you hurt. You are asked to cough and take deep breaths often to help keep your lungs clear. DAY AFTER SURGERY Blood is drawn in the early morning for testing. The nurse monitors how well your pain medicine is working and makes adjustments if necessary. Twice during the day, the physical therapist teaches you how to get out of bed and helps you walk a few steps. You also learn some exercises. If you had both knees replaced, the occupational therapist visits to help you practice techniques to improve your functioning. The therapist also discusses equipment that can help you at home. The RN case manager visits with you about your current living situation and potential discharge needs. Bed baths are given until your bandage is taken off. 2-3 DAYS AFTER SURGERY Blood is drawn early in the morning for testing. If you have a urinary catheter, it is removed. You are asked to drink plenty of fluids. This helps you urinate. You may want to take pain medications an hour before therapy sessions. Keep in mind you may not have pain while resting, but will likely have pain during activity. The physical therapist will see you twice per day. The therapist assists with exercises and walking in your room and down the hall. You may practice climbing stairs, getting in and out of bed, and getting in and out of a car. The occupational therapist may be back to practice use of equipment to promote independence. You may shower if the bandages have been removed or with your dressings covered. The nurse helps you. An RN case manager visits with you regarding your discharge needs and arrangements. You may be discharged home or to rehab on Day 2 if your progress allows. If not, expect to be discharged on Day 3. Most people go home with prescriptions for pain pills and blood thinning medicine (2- to 4-week supply). Your nurse discusses your discharge, including medications, your doctor s discharge instructions, follow-up appointments and blood tests, if needed. Any questions or concerns you may have about your recovery at home are answered. An ice unit may be recommended by your surgeon for home use. Surgery Surgery usually lasts one to three hours, but varies with each person. While you are in surgery, your family may relax in the surgery waiting room. After surgery, you are taken to the recovery room for about an hour. The doctor informs your family about your condition. While resting in this area: Your blood pressure, breathing, and other vital signs are watched closely. Medicines for pain and nausea are available if you need them. Your family may see you once you are transferred from the recovery room to your room on the Orthopedic Unit. 8 Total Knee Replacement Total Knee Replacement 5
Care After Surgery (Orthopedic Unit) Pain Relief During the first 24 hours after the operation, a nurse checks your breathing, pulse, and blood pressure frequently, and changes your body position as needed. You are asked to move your feet and legs often to help blood flow in your legs. Staff help you get out of bed, stand, and/or take a few steps the day after surgery. Your family may help with your personal hygiene needs if desired. You may have ice chips and sips of water. Your first meal is liquid. Regular meals are usually served the next day. An ice bag is placed on your knee dressing to relieve pain and minimize swelling and bleeding. A tube (urinary catheter) may be inserted into your bladder to drain urine. It is usually removed in 2 days. You will be provided supplemental oxygen until the morning after surgery. You may need it longer. Breathing exercises are important in the first few days after surgery. You are asked to cough, breathe deeply, and perform other lung exercises to prevent fluid from collecting in your lungs. Gas pain and constipation are common after surgery. Increasing your physical activity, eating a high-fiber diet, and drinking plenty of fluids help prevent these problems. If you need a laxative during your hospital stay, please tell your nurse. CONTINUOUS PASSIVE MOTION MACHINE (CPM) Your doctor may order the use of a continuous passive motion (CPM) machine. It keeps your knee joint in a very slow, continual motion. This increases circulation and prevents your knee from becoming stiff. Your doctor orders when to start use of the CPM. Some of the benefits include: Increased circulation. Decreased pain. Improved motion in your knee joint. The amount of time you use the CPM can vary. Let the nurse know if you get tired of being on your back. The nurse checks your upper thigh and heel often for irritated areas. Let the nurse know if the CPM burns or hurts your leg. It is common to have some pain after surgery. Pain is not eliminated completely, but can be reduced to a slight to moderate level. Our goal is to make your stay and recovery as comfortable as possible. Everyone experiences pain differently. We ask you to decide what your own pain goal is. We use a pain scale to help describe your pain. This helps us determine the proper type and amount of pain medicine to use. 0 2 4 6 8 10 Pain is controlled best when you take medicine before the pain becomes severe. Be sure to tell your nurse when you are having pain. Most pain medications are on an as needed basis to reduce side effects. Helping Circulation Good circulation is important to promote healing. There are several things that are done to help prevent circulation problems in your legs, such as blood clots or swelling. These may include: TED hose. You may be fitted with either thigh-high or knee-high support hose called TEDs. These help prevent blood clots from forming in your legs. Tell the nurse if you have any tight or burning areas beneath the hose. Blood-thinning medicine may be ordered to help prevent blood clots; it may be given to you daily. Venous pumps. They have plastic sleeves that fit over your legs and massage them by inflating and deflating. This helps prevent blood clots. Gentle exercises. The nurse or rehab therapist shows you gentle exercises to help circulation, strengthen muscles, and improve range of motion. 6 Total Knee Replacement Total Knee Replacement 7