DEPARTMENT OF ORTHOPAEDIC SURGERY TOTAL KNEE REPLACEMENT

DEPARTMENT OF ORTHOPAEDIC SURGERY TOTAL KNEE REPLACEMENT A P A T I E N T GUIDE

Cotets Preparig for your surgery... 2 The day before your surgery... 10 The day of your surgery... 11 Gettig the most out of your surgery... 14 Exercise ad physical therapy... 15 Resumig your ormal activities... 17 Risk factors ad complicatios... 26 Notes... 28 Special topics About blood trasfusios... 3 Readyig your home... 4 Plaig ahead for your discharge... 5 Gettig to the hospital... 6 Aesthesia... 7 What ad what ot to brig to the hospital... 8 Surgery preparatio checklist... 9 Arthritis of the kee... 12 Pai maagemet... 14 Your care team... 15 Takig care of your surgical icisio... 17 Early postoperative exercises... 18 Advaced exercises ad activities... 20 Gettig aroud after your surgery... 24

Preparig for your surgery Preparatio for your total kee replacemet surgery begis several weeks before the date of the surgery itself. To begi with, you will be asked to keep the followig appoitmets: Pre-admissio testig: This is a physical examiatio ad a series of tests (X-rays, blood work, etc.) that will be performed i preparatio for your surgery. Durig pre-admissio testig you will also meet with a aesthesiology staff member to discuss the type of aesthesia you will udergo. Medical clearace for surgery: Approval for you to udergo surgery is required from your primary doctor or we ca arrage for you to be examied by oe of our doctors. This examiatio, i combiatio with pre-admissio testig, is ecessary to review your overall health ad idetify ay medical coditios that could iterfere with your surgery or recovery. Kee replacemet class: You will be scheduled to take a twohour class where our staff will review the most importat iformatio covered i this guide ad aswer ay other questios you might have about your surgery. If schedulig permits, we will arrage for you to take this class the same day as pre-admissio testig. I the weeks before your surgery you may also be asked to: Begi exercisig uder a physicia s supervisio: It is importat to be i the best possible physical coditio for your surgery. Special exercises to icrease your upper body stregth will help you use a walker or crutches i the early days after surgery, ad exercises that stregthe your legs ca reduce recovery time. Watch your weight: If you are overweight, losig weight will help reduce stress o your ew joit. (If your weight is ormal, keep it that way.) Cosider pre-doatig blood for trasfusio: If your surgeo determies that your operatio may require a blood trasfu- 2 U C D a v i s o r t h o p a e d i c s u r g e r y

A b o u t b l o o d t r a s f u s i o s Patiets udergoig joit replacemet surgery may require a blood trasfusio. You should discuss this with your surgeo. If you are a cadidate for trasfusio, you have several optios: Autologous trasfusio. A autologous trasfusio is oe i which you doate your ow blood ahead of time. Your surgeo s office will istruct you how to make a appoitmet to pre-doate blood at Sacrameto Blood Source, or other arragemets ca be made. The process is extremely reliable, ad your blood ca be refrigerated safely for at least a moth. The obvious advatage of this optio is that whe your ow blood is used there is o risk of cotractig a trasmissible disease from someoe else s. (Please ote that it is possible for your surgical team to cotract a trasmissible disease from you. If you have such a coditio, please share this iformatio with your caregivers.) Homologous trasfusio. A homologous trasfusio is blood that comes from a door. While this ofte is blood from a aoymous door, a family member or fried who has your blood type ca doate a directed door uit reserved specifically for you. All homologous uits of blood, whatever the source, are tested by the blood bak for trasmissible diseases. Erythropoieti. I some special circumstaces, your surgeo may recommed that you receive erythropoieti, a hormoe that is aturally produced by the kidey ad also commercially produced i a laboratory for treatig certai patiets with a low red blood cell cout (aemia). Erythropoieti give to a patiet preoperatively may reduce the eed for homologous trasfusios (bak blood). Although costly, this medicatio is usually covered by isurace. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 3

sio, you ca choose to doate your ow blood ahead of time. Have a detal examiatio: Although ifectios i joit replacemets are ot commo, oe ca occur if bacteria eter the bloodstream somewhere else i your body. Therefore, you should arrage to have detal procedures such as extractios ad periodotal work completed before your surgery. Readyig your home There are several thigs that you (or a fried or family member) ca do before eterig the hospital to make your home safer ad more comfortable upo your retur: I the kitche ad elsewhere, place items that you use regularly at arm level so you do ot have to reach up or bed dow. To avoid usig stairs, cosider temporarily chagig rooms for example, by makig the livig room your bedroom. Rearrage furiture to give yourself eough room to maeuver with a walker or crutches. Remove loose carpets ad rearrage electrical cords i the areas where you will be walkig. A footstool will be useful for keepig your operated leg straight out i frot of you whe you sit. Pla to wear a big-pocket shirt or soft shoulder bag for carryig thigs aroud. Set up a recovery ceter i your home, with the phoe, televisio remote cotrol, radio, facial tissues, wastebasket, pitcher ad glass, readig materials, ad medicatios withi reach. 4 U C D a v i s o r t h o p a e d i c s u r g e r y

Stop takig certai medicatios: Your surgeo ca tell you which medicatios to stop takig before your surgery. Be certai to tell your physicia all the medicatios that you are takig, icludig over-the-couter medicatios, because some of these may icrease your bleedig durig surgery. Be sure your postoperative medicatio will be available: Ask your surgeo ahead of time whether you will require aticoagulatio medicatio (to prevet blood clots) after your surgery. If you do, call your pharmacy to esure that it has it i stock. Plaig ahead for your discharge Whether or ot you require rehab followig your surgery depeds o several factors, icludig your geeral state of health. Most patiets ca be safely discharged directly home. If your surgeo determies otherwise, a member of our Discharge Plaig Departmet will visit you a day or two after your surgery to give advice ad help prepare the ecessary paperwork for etry ito a rehabilitatio facility. Every patiet is visited by a discharge plaer who works with you, your surgeo, ad your isurace provider to make your discharge from the hospital as smooth as possible. If you have ay cocers about your ability to maage your persoal care, mobility, medicatios, or other recovery eeds oce you retur home, brig them up with your case maager ad/or discharge plaer: They are traied to help you i these matters. Oce you are home, we cotiue to provide care. Depedig o your eeds, a member of our Discharge Plaig Departmet ca arrage for a visitig urse, a home therapist, or i some cases a home health aide to check o you several times durig the week for the first few weeks after your surgery. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 5

Stop smokig: This is a good idea at ay time, but particularly before major surgery i order to help reduce the risk of postoperative lug problems ad improve healig. Evaluate your eeds for at-home care after discharge from the hospital: Most kee replacemet patiets will eed help at home for the first few weeks, icludig assistace with preparig meals ad trasportatio. Tell your surgeo about your curret support services/devices: If you are ow usig a home service, brig the ame ad phoe umber of the service to the hospital. If you have medical equipmet such as a wheelchair, crutches, or walker at home, ask your surgeo if you should make arragemets to have the equipmet brought to the hospital for the physical therapist to make adjustmets. Review your isurace: A surgery coordiator will request authorizatio for your surgical procedure. It would be a good idea, however, to cotact your isurace compay well ahead of time to familiarize yourself with the beefits available to you. For example, differet isurace providers have differet rules for determiig the medical ecessity of rehabilitatio, ad most do ot provide a beefit for your trasportatio home. G e t t i g t o t h e h o s p i t a l See the iside back cover of this booklet for directios to the mai hospital of UC Davis Medical Ceter. Or, you ca view directios ad maps o the iteret at: www.ucdmc.ucdavis.edu/healthcosumers/maps 6 U C D a v i s o r t h o p a e d i c s u r g e r y

Aesthesia Aesthesia is the process of iducig a pai-free, traquil, sleeplike state for your surgery. Your aesthesiologist has several techiques to carry you through surgery comfortably ad without pai. Some medical coditios may make oe techique preferable. You should discuss this with both your surgeo ad your aesthesiologist. Whichever techique is chose, be assured that your operatig room experiece will be a pailess ad traquil oe. Geeral aesthesia. First you are give medicatio to iduce a sleep-like state, followed by a gas aesthetic aget admiistered via a mask ito your lugs. Throughout the operatio you will be attached to moitors that display iformatio o your heart rhythm ad rate, oxyge level i your bloodstream, body temperature, ad blood pressure. Your aesthesiologist cotiually checks these moitors. Regioal aesthesia. Some patiets reject regioal aesthesia because they thik that they will be awake durig the procedure. This is ot true. I regioal aesthesia, you also receive medicatios that allow you to sleep peacefully throughout the operatio. Ulike geeral aesthesia, whe regioal aesthesia is discotiued you will awake almost immediately ad without pai (because the aesthesia is still workig). Two types of regioal aesthesia are commoly used: spial ad epidural. I additio, regioal erve blocks (femoral erve, sciatic erve) are icreasigly beig used as a adjuct to miimize post-operative pai. All of these may be used i combiatio. Whe this type of aesthesia is used, you are moitored as described above for geeral aesthesia. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 7

W h a t T O b r i g a d w h a t N O T t o b r i g Brig to the hospital Your cae or crutches, if eeded Eyeglasses ot cotact leses Detures/hearig aid. A cotaier will be provided for these, which you should keep o your bedside table or i a drawer ot o the bed or a food tray. A list of your medicatios, icludig the oes you have recetly stopped takig at your surgeo s request Importat telephoe umbers Small amout of cash for ewspapers, etc. A book, magazie, or hobby item for relaxatio This booklet Completed Advace Health Care Directive.. (optioal) DO NOT Brig to the hospital Medicatios uless asked by your surgeo Valuables jewelry, large amouts of cash, credit cards All hospital staff members respect your property rights, but we caot guaratee security for your persoal property. 8 U C D a v i s o r t h o p a e d i c s u r g e r y

Keepig track of all this iformatio ca be overwhelmig. Please feel free to ask questios or share cocers with ay of your caregivers at ay time. Your Kee Replacemet Class (see page 2) is oe good place to get aswers. Ad remember that you ca cotact your surgeo or your surgeo s case maager at ay time. S u r g e r y p r e p a r a t i o c h e c k l i s t The ight before your surgery: Shower (may be doe day of surgery if time permits). Do ot eat or drik after midight. Review this guide. Get a good ight s rest. The day of your surgery: Take routie medicatios with oly a sip of water as istructed by your doctor. Brush your teeth ad rise without swallowig. Wear comfortable clothig. Leave valuables at home or with a family member. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 9

The day before your surgery You will receive a telephoe call from the hospital after 1 p.m. o the weekday before your surgery tellig you whe to come to the hospital ad exactly where to go. For example, if your surgery is o Tuesday, the hospital will call you o Moday ight; if your surgery is o Moday, the call will be o Friday ight. Your arrival may be scheduled for as early as 5:30 a.m., so be sure to get a good ight s sleep. It is importat that you arrive o time because if you are late, your surgery will have to be rescheduled. Diet: You may eat ormally o the day before your surgery, but do ot drik alcohol. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT. This is importat so that it will ot iterfere with your aesthesia. The oly exceptio is if your doctor gives specific istructios to take medicatio with a sip of water. Shower ad shampoo either the ight before or the morig of your surgery. 10 U C D a v i s o r t h o p a e d i c s u r g e r y

The day of your surgery O the day of surgery: You may brush your teeth ad rise your mouth without swallowig ay water. Wear comfortable, loose-fittig clothig ad flat, o-slip, walkig or athletic shoes. Leave valuable possessios at home or give them to a family member for safekeepig. (See What ad what ot to brig to the hospital, below.) Oce you arrive at the hospital: You will be provided with a gow. Your ow clothig ad persoal belogigs will be safely stored. You will be asked to fill out a operative coset form, to review it, ad to sig it alog with your surgeo ad a thirdparty witess. (If this was doe previously, your surgeo will review the form with you agai.) Your surgeo will also place his/her iitials over the operative site as a extra precautio. Your aesthesiologist will go over with you the type of aesthesia to be used for your surgery. After that explaatio, you will be asked to complete, review ad sig a coset form specifically for the aesthesia. Whe the operatig room is ready, you will be escorted there by a urse. Durig your surgery, your family ad frieds may wait i ay of several comfortable hospital locatios. They should check i at the iformatio desk so your surgeo ca be made aware that they are waitig. With your permissio, your surgeo will visit with them or call ad speak with them after your surgery is completed. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 11

Arthritis of the kee Arthritis of the kee is a coditio i which the smooth glidig surfaces of your kee joit (articular cartilage) have become damaged. This usually results i pai, stiffess, ad reduced flexibility. The most commo type of arthritis, osteoarthritis, typically develops i older patiets due to a lifetime of wear ad tear. It ca also occur i someoe whose kee did ot develop ormally. Less commo forms of arthritis iclude traumatic arthritis, which develops as a result of a ijury, such as a fracture i the kee joit that does ot heal properly, ad rheumatoid or iflammatory arthritis, which results from a iflammatory coditio or autoimmue disease. Normal kee I a X-ray of a ormal kee, the articular cartilage (the area labeled ormal joit space ) is clearly visible. I total kee replacemet surgery, the portios of the kee joit that cotai the damaged surfaces are replaced with biocompatible devices that provide a smooth ad pailess rage of motio. Your surgeo will make every effort to restore your kee to a coditio that resembles its healthy preoperative status ad to correct ay deformity that may have existed. You should discuss what realistic outcome to expect with your surgeo. 12 U C D a v i s o r t h o p a e d i c s u r g e r y

Arthritic kee O this X-ray, the joit space has bee greatly reduced. Wherever there is complete loss of cartilage, the coditio is kow as boe-oboe. Total kee replacemet Implats achored iside the femur (thigh boe) ad tibia form a ew joit that is held i place by muscles ad soft tissues. Implats may be secured to your boe by cemet or they may have. textured surfaces to ecourage boe igrowth. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 13

Gettig the most out of your surgery Whe your surgery is complete you will be take to a recovery room, where you will sped two to three hours before beig moved to your regular hospital room. Family ad frieds will be reuited with you oce you are settled i. Depedig o your aesthesia, your medical history ad other factors, you may first be take to a moitored bed eviromet (either the Itesive Care Uit or the Post-Op Uit). Your surgeo or aesthesiologist will discuss this with you before your surgery. Your care team will moitor your progress throughout your hospital stay to esure your safe ad efficiet recovery. Amog other thigs, they will periodically check your vital sigs temperature, blood pressure, etc. ad chage the dressigs that cover your icisio. Your surgeo may also decide that you ca beefit from a blood trasfusio, a blood-thiig medicatio or automatic foot pump device to prevet clot formatio, a icetive spirometer that helps keep your lugs clear, ad/or a cotiuous passive motio machie that automatically exercises your kee: All these thigs will be atteded to by your care team. Pai maagemet May patiets are uderstadably cocered about postoperative pai. Pai cotrol has become very sophisticated. Usually the level of discomfort is easily maageable with oral or ijected pai medicatio. Some patiets receive IV-PCA itraveous patietcotrolled aalgesia for a day or two followig surgery: This allows the patiet to self-admiister a safe ad effective amout of pai medicatio through a IV tube by pressig a butto. Similarly, i some cases a epidural catheter that automatically delivers pai medicatio may be left i place for 24 hours followig surgery. 14 U C D a v i s o r t h o p a e d i c s u r g e r y

Your care team Your surgeo Nurses Nurse practitioers Physical therapist or occupatioal therapist Fellows ad residets: licesed physicias udergoig specialized postgraduate traiig i orthopaedic surgery Iterist: a specialized physicia selected by your surgeo to assist i the medical maagemet of your postoperative care Pai specialists: a physicia ad a urse practitioer who specialize i pai maagemet Rehabilitatio specialist: a physicia traied to determie the level of care you will require oce you leave the hospital Oe or more of the above care team physicias, depedig o your eeds, will visit you o rouds every day that you are i the hospital. Exercise ad physical therapy The day after your operatio, your urses, physical therapists ad other caregivers will start you o a course of treatmet that will prepare you for life with your ew kee. Some patiets are provided with a cotiuous passive motio machie (CPM machie) o the day followig surgery. This device begis getle movemet of your ew kee, without ay effort o your part, ad is used while you are i bed. If the kee becomes stiff durig the first moth or so after surgery, your surgeo may recommed a kee maipulatio. (A small percetage of kee replacemet patiets eed this. You would be A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 15

brought back to the operatig room where uder aesthesia your kee is bet ad straighteed i order to break up scar tissue.) Your active participatio is eeded to avoid this, so if you are bothered by discomfort durig exercisig, ask your surgeo or pai specialist for additioal pai-maagemet strategies. O the morig followig your surgery, a physical therapist will assist you to a stadig positio, ad usig a walker, you will begi to walk o your ew kee. I most cases you will be allowed to put all your weight o your ew kee; this is called weightbearig as tolerated. Sometimes, because of the ature of your surgery, your surgeo may decide that at first you should place oly part of your weight o your operated leg: This is called partial weightbearig. As time passes, you will be able to icrease the amout of weight that you place o the operated side to weightbearig as tolerated. Your surgeo will leave specific istructios with your physical therapist. By about the third day after your surgery, you will be walkig with greater cofidece, ad be ready for discharge. Your occupatioal therapist will teach you special techiques for dressig, bathig ad climbig stairs. Most patiets are surprised at how idepedet they become, ad how quickly. For the first four to six weeks followig surgery, most of our patiets require ad receive some form of therapy: either home therapy, outpatiet therapy, or therapy as part of care i a rehabilitatio facility. Your active participatio i physical therapy is critical to a successful surgical outcome followig total kee replacemet. The kee joit requires movemet after surgery to prevet the formatio of scar tissue that would make the kee stiff. Your physical therapist will istruct you o exercises that will help your kee regai its flexibility ad stregth. It may be recommeded that you exercise 20 to 30 miutes three times a day: morig, afteroo, ad ight. (See the istructios for exercises startig o page 18.) 16 U C D a v i s o r t h o p a e d i c s u r g e r y

Resumig your ormal activities Most kee-replacemet patiets experiece a dramatic reductio i joit pai ad a sigificat improvemet i their ability to participate i the activities of daily livig. Be aware, however, that recovery takes time. Expect to feel a bit more tired tha usual for a few weeks. Your surgery is a major evet. Give yourself time to regai your stregth ad self-cofidece. Stay active just do t overdo it! You will otice a gradual improvemet over time i your stregth ad edurace. (cotiued o page 22) Ta k i g c a r e o f y o u r s u r g i c a l i c i s i o Your surgical icisio will be closed usig sutures or staples that will be removed about two weeks after your surgery. (I some cases resorbable sutures are used that do ot eed be removed.) The followig apply to takig care of your woud: Keep the area clea ad dry. A dressig will be applied to the site i the hospital ad should be chaged as ecessary. Ask for istructios o how to chage the dressig if you are ot sure. Oce draiage has stopped you may leave the dressig off. Notify your doctor if the woud appears red or begis to drai. Some swellig is ormal for the first three to six moths after surgery. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 17

E a r l y p o s t o p e r a t i v e e x e r c i s e s These exercises are importat for icreasig circulatio to your legs ad feet to prevet blood clots. They also are importat to stregthe muscles, improve your kee movemet ad prevet the formatio of scar tissue that would make the kee stiff. Do ot give up if some exercises feel ucomfortable at first: They will speed your recovery ad reduce your postoperative pai. All exercises should be doe SLOWLY. Not every exercise is appropriate for every patiet. Your therapist will check off the exercises that are right for you. Uless otherwise idicated, do these exercises every day i three sessios: morig, afteroo ad ight. Akle pumps: Slowly move your foot up ad dow. Do this exercise several times as ofte as every five or 10 miutes. This exercise ca be doe while you are either lyig dow or sittig i a chair. You ca begi this exercise immediately after surgery i the recovery room. Keep doig it periodically util you are fully recovered. Akle rotatios: Move your akle iward toward your other foot ad the outward away from your other foot. Repeat five times i each directio. This exercise ca be doe while you are either lyig dow or sittig i a chair. Straight leg raises: Tighte your thigh muscle with your kee fully straighteed o the bed. As your thigh muscle tightes, lift your leg several iches off the bed. Hold for five to 10 secods, the slowly lower your leg. Repeat this exercise 10 times for each leg (ot just your operated leg). 18 U C D a v i s o r t h o p a e d i c s u r g e r y

Quad set: Tighte your thigh (quadriceps) muscle. Try to straighte your kee while pushig the back of your kee to the bed. Hold for five to 10 secods. Repeat this exercise 10 times for each leg (ot just your operated leg). Kee-straighteig exercises: Place a small, rolled-up towel uder your leg just above your heel so that your heel is ot touchig the bed. Tighte your thigh. Try to fully straighte your kee ad to touch the back of your kee to the bed. Hold fully straighteed for five to 10 secods. Repeat util your thigh feels fatigued. Sittig supported kee beds: Sit o a bed or chair with your thighs supported. Alterately straighte ad bed your kee, usig the foot of your uoperated leg to push your operated leg up (left-had illustratio) ad back (right) as far you ca. Hold your kee i the full bet/straighteed positio for five to 10 secods. Repeat several times util your leg feels fatigued or util you ca completely bed ad straighte your kee. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 19

Sittig usupported kee beds: Sit o a bed or chair with your thighs supported. Bed your kee as far as you ca util your foot rests o the floor. With your foot lightly restig o the floor, slide your upper body forward i the chair to icrease your kee bed. Hold for five to 10 secods. Straighte your kee fully. Repeat several times util your leg feels fatigued or util you ca completely bed your kee. Bed-supported kee beds: Bed your kee as much as possible while slidig your foot o the bed. Hold your kee i a maximally bet positio for five to 10 secods ad the straighte. Repeat several times util your leg feels fatigued or util you ca completely bed your kee. Advaced exercises ad activities A full recovery will take time. The pai from your problem kee before your surgery ad the pai ad swellig after surgery have weakeed your kee muscles. The followig exercises ad activities will help your kee muscles recover fully. Stadig kee beds: Stadig erect with the aid of a walker or crutches, lift your thigh ad bed your kee as much as you ca. Hold for five to 10 secods. The straighte your kee, touchig the floor with your heel first. Repeat several times util fatigued. 20 U C D a v i s o r t h o p a e d i c s u r g e r y

Assisted kee beds: Lyig o your back, place a folded towel over your operated kee ad drop the towel to your foot. Bed your kee ad apply getle pressure through the towel to icrease the bed. Hold for five to 10 secods. Repeat several times util fatigued. Kee exercises with resistace: You ca perform ay of the early or advaced exercises with light weights aroud your akle. (Iexpesive wraparoud akle weights with Velcro straps ca be purchased at most sportig goods stores.) These resistace exercises usually ca begi four to six weeks after your surgery. Use oe- to two-poud weights at first; gradually icrease the weight as your stregth returs. Statioary bicycle exercise: Exercisig o a statioary bicycle is a excellet activity to help you regai muscle stregth ad kee mobility. Adjust the seat height so that the bottom of your foot just touches the pedal with your kee almost straight. Pedal backwards at first. Pedal forward oly after a comfortable backwards cyclig motio is possible. As you become stroger (at about four to six weeks) slowly icrease the tesio o the pedals. Pedal forward 10 to 15 miutes twice a day, gradually buildig up to 20 to 30 miutes three to four times a week. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 21

Resumig your ormal activities (cotiued from page 17) Oce you are home, you will wat to keep track of the state of your ew kee as well as your geeral health for several weeks. I particular: Take your temperature twice daily ad otify your doctor if it exceeds 100.5 F. Take all medicatios as directed. Notify your doctor immediately if you otice tederess, redess, or pai i your calf, chest pai, ad/or shortess of breath. These are all sigs of a possible blood clot. Because you have a artificial joit, it is especially importat to prevet bacteria from eterig your bloodstream that could settle i your joit implat. You should take atibiotics wheever there is the possibility of a bacterial ifectio, such as whe you have detal work. Be sure to otify your detist that you have a joit implat; they are traied to prescribe atibiotics for you to take by mouth prior to a extractio, periodotal work, detal implat, or root caal work. Diet. By the time you come home from the hospital, you should be eatig a ormal diet. Your physicia may recommed that you take iro ad vitami supplemets. Cotiue to drik plety of fluids ad avoid excessive itake of vitami K if you are takig the blood-thiig medicatio Coumadi (warfari). Foods rich i vitami K iclude broccoli, cauliflower, brussels sprouts, liver, gree beas, garbazo beas, letils, soybeas, soybea oil, spiach, kale, lettuce, turip grees, cabbage ad oios. Try to limit your coffee itake ad avoid alcohol altogether. You should cotiue to watch your weight to avoid puttig more stress o the joit. 22 U C D a v i s o r t h o p a e d i c s u r g e r y

Basic activities. Geerally, the followig guidelies will apply: Weightbearig: Be sure to discuss weightbearig restrictios with your physicia ad physical therapist. Their recommedatios will deped o the type of implat ad other issues specific to your situatio. Drivig: You ca begi drivig a automatic shift car i four to eight weeks, provided you are o loger takig arcotic pai medicatio. If you have a stick shift car, this may take loger. The physical therapist will show you how to slide i ad out of the car safely. Placig a plastic bag o the seat ca help. Sexual relatios ca be safely resumed four to six weeks after surgery. Sittig, sleepig positios: There are o restrictios o sittig or sleepig positio; just fid a comfortable positio. Retur to work: Your surgeo will determie whe you are medically fit to retur to work. I your first follow-up visit (usually four to six weeks after your surgery), if everythig is ormal your surgeo may give you the go-ahead to retur to work full-time. If your work is ot too physically demadig ad you feel up to it, you ca retur to work eve earlier, at least part-time (perhaps a few hours oce or twice a week). Do t push yourself too hard. If your work is more physically demadig, it may take more time (approximately three moths) to retur to work. Other activities: Walk as much as you like oce your doctor gives you the go-ahead, but remember that walkig is o substitute for your prescribed exercises. Swimmig is also recommeded. You ca begi swimmig as soo as your surgeo has determied that your surgical woud is well healed. By three moths, most patiets ca retur to a active lifestyle, which could iclude golfig, bowlig, bike ridig, dacig, playig doubles teis, ad, i some cases, eve skiig. Most surgeos discourage high-impact aerobic activities like joggig ad basketball. Do ot do ay heavy liftig (more tha 40 pouds) or perform weightliftig exercises. Discuss your activities with your surgeo to be sure. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 23

Gettig aroud after your surgery Walkig with a walker or crutches: Stad comfortably ad erect, with your weight evely balaced o your walker or crutches. Move your walker or crutches forward a short distace. The move forward, liftig your operated leg so that the heel of your foot touches the floor first. As you move forward, your kee ad akle will bed ad your etire foot will rest evely o the floor. As you complete the step, allow your toe to lift off the floor. Move your walker or crutches agai, ad reach forward with your hip ad kee for your ext step. Remember, touch your heel first, the flatte your foot, the lift your toes off the floor. Walk as rhythmically ad smoothly as you ca, but do t hurry. Adjust the legth of your step ad speed as ecessary to walk with a eve patter. As your muscle stregth ad edurace improve, you may sped more time walkig. Gradually, you will put more ad more weight o your leg. Walkig with a cae or sigle crutch: A walker is ofte used for the first several weeks to help your balace ad to avoid falls. A cae or sigle crutch is the used for several more weeks util your full stregth ad balace have retured. Use the cae or crutch i the had opposite the operated kee. You are ready to use a cae or sigle crutch whe you ca walk ad stad for more tha 10 miutes. Climbig ad descedig stairs: Goig up ad dow stairs requires both flexibility ad stregth ad so should be avoided if possible util healig is complete. If you must use stairs, you may wat to have someoe help you util you have regaied most of your stregth ad mobility. Always use a hadrail for support o the side of your u.affected leg ad move up or dow the stairs oe step at a time: 24 U C D a v i s o r t h o p a e d i c s u r g e r y

Goig up stairs: 1. Step up o your uaffected leg. 2. Next step up o your operated leg. 3. Fially brig up your crutch(es) or cae(s). Goig dow stairs, reverse the process: 1. Put your crutch(es) or cae(s) o the. lower step. 2. Next step dow o the operated leg. 3. Fially, step dow o the uaffected leg. Remember to always lead UP the stairs with your uaffected leg, ad DOWN the stairs with your operated leg. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 25

Risk factors ad complicatios There are risks i ay type of surgery, ot just kee replacemet surgery. The geeral risks of kee replacemet surgery such as a bad reactio to aesthesia or heart attack are o greater tha i most other types of surgery. To help prevet a blood clot, your surgeo may prescribe a blood-thiig drug (such as Coumadi or Loveox). Alteratively, or i additio, pumpdrive compressive devices may be applied to your legs followig surgery to reduce the chaces of clot formatio. The followig are amog the possible complicatios followig kee replacemet surgery. While this list is ot complete, it icludes complicatios you should be aware of. Blood clots. Oe of the risks of kee replacemet surgery is the developmet of blood clots i the legs. I additio to early ambulatio ad leg compressio hose/devices, your surgeo will place you o a aticoagulat (blood thier) medicatio, either a pill (Coumadi) or a shot (Hepari). If o Coumadi, your blood levels will be eed to be moitored twice a week upo discharge. A pharmacist from the UC Davis aticoagulat cliic will otify you of ecessary dosage chages, which is commo for Coumadi therapy. Please set a time i the late afteroo (i.e., 5 p.m.) to routiely take your medicatio. If you do ot hear from the aticoagulatio cliic or your home health urse before your scheduled dose, take the same dose you took the day before it ca be adjusted later if eeded. If you are takig a ijectable aticoagulat you will be istructed how to do so i the hospital ad asked to give a demostratio to cofirm. It is advised that you pick up your prescriptio from the hospital pharmacy as your local pharmacy may ot have it i stock. Implat looseig ad wear. The typical kee replacemet has a 90-95 percet probability of fuctioig well for more tha 10 years. This is still ot forever. Over time, the implat may show sigs of wear, or it may loose, ad so may require a secod replacemet ( revisio ). Cotiuig research promises to icrease implat lifetimes ad make replacemet eve easier i 26 U C D a v i s o r t h o p a e d i c s u r g e r y

the future. Feel free to discuss the curret state of techology with your surgeo regardig implat desigs. Ifectio. Although ifectio i a kee replacemet is relatively rare, it is a serious complicatio that requires urget, aggressive treatmet. May ifectios ca be avoided. For example, stadard detal procedures, icludig routie cleaig, carry the risk of bacteria eterig your bloodstream ad ifectig your kee implat. Takig a atibiotic approximately a hour before your procedure ca greatly reduce or elimiate this risk. The same rule applies to medical procedures such as surgery or eve a colooscopy. Ask your surgeo for guidace whe you are scheduled for oe of these procedures. Nerve or blood vessel ijury. There is a risk of damage to erves or blood vessels i kee replacemet surgery as i ay other kid of surgery but it is extremely low. After surgery, sometimes just the positio of your leg o the bed or o the CPM machie may cause pressure agaist a erve alog the outside of your kee. If you experiece sudde umbess or weakess i your leg or foot i the days followig surgery, otify your urse or doctor immediately. Metal alloys ad metal detectors. Your ew kee is made of metal alloys. There are some thigs you will have to keep i mid. Most likely you will activate metal detectors foud i courthouses ad airports. Be sure to give yourself plety of time to be maually assessed ( waded ). Some equipmet vedors provide a card that you ca carry i your wallet. If provided it would be mailed sometime after your surgery. Remember, though, card or o card, you will be pulled aside ad maually checked. MRI (Magetic Resoace Imagig). You should ot have ay difficulty with such tests if you eed them i the future. A p a t i e t g u i d e t o t o t a l k e e r e p l a c e m e t 27

Notes 28 U C D a v i s o r t h o p a e d i c s u r g e r y

We keep you movig Departmet of Orthopaedic Surgery 4860 Y Street, Suite 1700 Sacrameto, CA 95817 (916) 734-2700 www.ucdmc.udcavis.edu/orthopaedics