Preparing for Knee Replacement Surgery
Preparing for a total knee replacement begins several weeks before the actual surgery. Maintaining good physical health before your operation is important and activities that increase upper body strength will improve your ability to use a walker or crutches after the operation.
The physician may order blood tests and urinalysis before surgery to make sure that a urinary tract infection is not present. Urinary tract infections are common, especially in older women, and often go undetected. Your orthopaedic physician may ask you to see a medical doctor, especially if medical problems have been present in the past.
It is important that your teeth be in good condition. An infected tooth or gum may be a possible source of infection for the new knee. In addition, any blisters, cuts, or boils should be reported. If infection is found, surgery is generally delayed until the infection is cleared.
Will I need anything special at home?
You will need crutches and/or a walker and handrails for the stairs leading to your house. Optional things include a raised toilet seat and handrails around the toilet, bath areas and stairwells. Any scatter rugs should be removed and torn areas in the carpet or tile tacked down to prevent falling. In addition, watch out for pets that may get underfoot!
When preparing for surgery, you should begin thinking about the recovery period after you leave the hospital. Discharge from the hospital is usually in about three to four days and a patient with a new total knee replacement is strongly encouraged to have someone at home to assist with dressing, getting meals and so on for the first couple of weeks.
If assistance from someone at home is not possible, please discuss this with your discharge planner. It may be necessary to think about arranging to stay a few weeks in a skilled extended care facility, an acute rehab unit, or receive therapy at home with in-home care. To qualify for these options, you must meet certain criteria as directed by Medicare and/or your insurance carrier. If needed, outpatient therapy can be arranged in a facility near your home.
Due to changes in insurance coverage, it is necessary for most patients to visit the hospital before their actual surgery date. This visit usually lasts several hours, so plan to spend most of the day.
The day begins in the clinic, where an interview by the nursing staff concerning past medical history and current medications will be taken, as well as a chest x-ray. You may be instructed to stop taking your anti-inflammatory medications (Ibuprofen, Naprosyn, Relafen, DayPro, Aspirin) one week before surgery. You will be attending a teaching session, which will provide you with information about your surgery. There will also be time for discussion and questions. Bring a written list of past surgeries and of the medications and dosages that you normally take at home.
During your pre-op visit, blood will be drawn and lab tests done to insure that you are in good general health. X-rays are taken if necessary. Chest x-rays and an EKG are obtained if you have not had one taken for six months or if otherwise indicated. After all of these tests and exams are completed, a nurse will talk with you to determine the type of anesthesia that is best suited for you. Before you leave the hospital, make sure your questions are answered.
If at any time you become ill, such as with a cold or flu, you need to call your physician. You need to be in the best of health before surgery!
Deep Breathing Exercises: You should exercise your lungs every day before surgery by inhaling deeply through your nose, then slowly exhaling through your mouth. Repeat this three times and then cough two times, every 30 minutes. These exercises are necessary to remove any excess secretions that may settle in your lungs while you are asleep during surgery.
Ankle Pumps: You should pump your ankles back and forth 1,000 times every day before your surgery. This is your best defense against blood clots.
You need to practice all exercises given to you (on paper) during the pre-op visit.
Please bring crutches or a walker with you to the hospital, so we can make sure that the equipment is in good working order and set at the right height.
Are there any special instructions I should know about?
A shower, bath, or sponge bath should be taken the evening before and the morning of surgery with the medicated liquid soap that was given to you at the time of your pre-admission testing. Nail polish and makeup should be removed.
Unless instructed otherwise, do not eat or drink anything after midnight.
What should I bring to the hospital?
- Crutches or walker
- Good walking shoes (crepe or rubber soles)
- Pair of shorts or sweatpants and a t-shirt
- Pajamas and robe
- Toothbrush, toothpaste, deodorant and other personal items
- Electric razors only!
- Only two family members or friends may accompany and stay with you before surgery in the prep holding area
What happens after I arrive at the hospital?
You should arrive at the hospital at the instructed time and go to the Surgery Prep Area. The nurse will spend a few minutes making sure that you are still in good health and ready for surgery. The nurses will try to give you a good estimation of when you will be going into surgery. However, it is hard to predict how long every surgery is going to take, so expect some waiting time and bring something like a book, magazine or other quiet activity to help pass the time.
You will be taken to a pre-surgical care unit where you will be asked to change into a hospital gown. An intravenous (IV) will be started to administer fluids and medications during and after the surgical procedure. From there, you will be transported to the operating room. Your family and/or friends may accompany you part of the way and then will be instructed to wait in the Surgery Waiting Area. Your doctor will talk to your family after the surgery to report your progress.
How long does the surgery take?
It depends upon how complicated your particular knee problem is, but usually a total knee replacement takes about 60 to 90 minutes.