The Surgical Suite
Overview
3-5 Weeks Prior to Surgery
One Week Prior to Surgery
The Night Before Surgery
Directly After Surgery
Weeks Following Procedure
Overview:
Patients with severe knee pain, arthritis, or a select few other conditions may eventually undergo a total knee replacement. In the procedure, the rough and damaged ends of the bones in your leg (namely the thighbone, or femur, and the shinbone, or tibia) are removed so that prosthetic "caps" can be inserted into the bone. In addition, the patella, or knee bone, is replaced with a synthetic knee. The procedure is involved, but extremely routine. The American Academy of Orthopaedic Surgeons estimates that well over 200,000 total knee replacements, or TKRs for short, are performed every year . Although recovery from TKR takes time and dedication, it may bring a reduction in the pain and loss of motion you have incurred.
3-5 Weeks Prior to Surgery:
After the date has been set for your surgery, you should begin preparing for it. Keep your diet healthy and eliminate smoking and alcohol consumption as much as possible. Avoid any drastic weight loss, unless recommended by your doctor, as this may throw off your internal balance and may weaken your immune system. Your doctor may recommend a strength-training program to improve your recovery time and perfect the alignment of your legs.
Check in with your doctor's office: ensure that your doctor has your most recent insurance information, medical history, and prescriptions on file. In addition, make sure you understand the surgery. This site has many resources that explain the reasons, risks, and recovery associated with TKR. Do not be afraid to ask your doctor questions.
A total knee replacement will keep you off your feet for at least a couple of days, and you will likely be on crutches or using a walker for a few weeks. Bending your knees will be difficult until the late stages of physical therapy. As a result, consider a number of modifications you can add to your home: a lift on your bed or a raised toilet seat may make your life easier by minimizing the amount of bending you have to do. Visit a local medical equipment rental store to obtain these devices, as well as others that will make the recovery more comfortable. If you have never used crutches before, learn how to use them before the surgery so that you do not fumble with them when the time comes. Occasionally, blood may be necessary during the operation; if you feel more comfortable using your own, donate some at the hospital prior to surgery.
Even though the ACL is most often repaired in a minimally-invasive, arthroscopic procedure, you will still have to stay off your feet for at least a couple of days. Discuss your surgery with a friend, family member, or roommate to determine if they will be your "helper" after the surgery: someone to drive you home, make sure you are comfortable, and help you carry out the doctor's post-operative instructions. If your doctor feels you will need to take time off, make arrangements with your employers or instructors to do so.
One Week Prior to Surgery:
Your orthopedic surgeon may recommend a complete physical prior to the surgery to ensure your body can handle the rigors of the procedure. You may be called in for pre-operative Range-of-Motion tests, X-rays, or other tests. If you will be undergoing physical therapy after the procedure, as many TKR recipients do, consider meeting with the therapist beforehand to outline the postoperative goals. Meeting with both the doctor and the physical therapist establishes a standard of comparison for your recovery. During the visits, your blood pressure, range of motion, pain level and medication use will all be discussed to form this baseline. Any necessary tests should be done at least two days before the surgery.
In the week before the procedure, you should also stop taking aspirin or any non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuproferin (Advil or Motrin), acetominophen (Tylenol), and napoxen (Aleve), as these may interfere with clotting during or directly after the surgery. Make sure that both you and your appointed "helper" know the way to and from the hospital, as you will not be able to drive yourself home after the surgery. Pick up a book or movie, as you will be off your feet for at least a couple of days. You may want to cook meals a few nights before and keep them in the refrigerator or freezer so that they will be easily heated up after the surgery. If you are not a cook, collect a few delivery menus.
The Night Before Surgery:
Although you may be a little jittery, try to relax. Eat a sensible meal and go to bed early. Remove any jewelry you are wearing, and collect your insurance information, medications and directions to the hospital. Bathing the night before or the morning of surgery is recommended. Arrive early for the surgery-you do not want to rush to the hospital.
Directly After Surgery:
You will feel woozy as you come out of your general or even local anesthetic. A continuous passive motion machine may be hooked to your leg to reduce post-operative stiffness in the knee. You may feel sleepy, disoriented, and even nauseous after the procedure. As the medication wears off, you may also experience pain in the joint.
Pay attention to the doctor's instructions-you may want to have your "helper" listen as well-as he or she explains your early post-operative course. The doctor will explain to you how and for how long to use crutches, ice the knee, dress your surgical wound, bathe, and perform exercises to increase your range of motion and leg strength. Although leg lifts and bends are common after surgery, they should not be done unless a doctor orders them.
Weeks Following Procedure:
Your recovery will seem far slower than it really is. Gradually, by working with your doctor or physical therapist (under a doctor's orders), you will regain the strength you had in the leg before your injury through physical therapy. Exercises may include weight-training, flexion (bending) and extension (straightening), leg lifts and squats, deep knee bends, walking and cycling. These should only be done under the supervision of your doctor or physical therapist. Do not overdo it. Pushing yourself too hard or too fast will set your recovery back.
¹AAOS News Release - Knee replacement study shows annual $63.5 million cost-savings potential by delaying x-rays
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