We use the new Missouri Orthopaedic Institute in Columbia, a state-of-the-art, technologically advanced specialty orthopaedic hospital in the University of Missouri system. Such centers are specifically equipped for joint replacement surgery and national data show a lower risk of complications, such as infections, and better outcomes from hip and knee replacement surgery at such specialized centers.
Remember not to eat or drink anything, including gum, candy, chewing tobacco, etc. Avoid make-up, nail polish on fingers or toes, perfume, or cologne. Remove all jewelry in anticipation of surgery.
You will have to remove your contact lenses prior to going into the operating room. Bring glasses, if you have them, or bring solution and a holder for your contacts.
We routinely use a spinal anesthetic with sedation. This type of anesthesia is safer than general anesthesia for knee replacement surgery. In addition, we use a combination of injections and pain pumps. If you have any preference for a certain kind of anesthetic, please let us know. Modern anesthetic drugs ensure that you will probably remember very little, if anything, about the surgery, and are developed to ensure your safety and comfort.
Your family will wait in a designated waiting room while you are in surgery. They will be informed (usually by telephone) when surgery is completed and you are in the recovery room. You will remain in the recovery room for approximately 1½ to 2 hours before going to your room. Your family can see you once you have arrived in your room.
Early pain is almost eliminated with modern pain medications and anesthetic techniques. Recovery from surgery is far more comfortable today than it was just a few years ago. Pain medications may be given through a fine catheter in your back, or may be injected close to the femoral nerve.
Pain medications may also be given in the form of a patient-controlled analgesic (PCA) which runs into the IV; you control the dosing. The knee joint itself and the tissues around it are injected with local pain-killing drugs.
If you have been taking narcotic drugs before surgery, pain control after surgery is usually more difficult since the body is already desensitized to the pain killers. In such cases, we typically use a higher dose of pain killers, and sometimes use a combination of drugs.
Pain medicines can be given by mouth, intravenously, or by intramuscular injection. If you hurt, please let someone know; we want to minimize discomfort and customize the treatment for you.
By the time you leave the hospital, your pain will be properly controlled by an oral pain medication. Depending on the patient, such medications may be taken for several weeks to several months.
You will be monitored in the recovery room for about an hour, and most patients are reasonably alert by this time.
You will notice a bulky dressing on your knee and an ice pack. This ice pack helps to control pain and swelling. You may also have a drain in the incision that looks like a plastic tube; this is removed within 24 to 48 hours. Expect a catheter in your bladder to keep urine drained; this is usually removed within 24 hours.
After an hour or so the nursing staff will take you to a private room on a floor that has expertise in caring for knee surgery patients. If your family plans to stay in the hospital room with you, please talk to your nurse so that arrangements can be made.
The nursing staff will coach you to take frequent deep breaths after surgery. You will have a breathing device to help with this. This is a plastic breathing exercise machine designed to prevent pneumonia and keep the lungs healthy.
You may have an overhead trapeze or lift on your bed to assist you in moving independently. This allows you to use your arms to move your body. Feel free to position your body in any way you want after knee surgery. The knee can be bent or straight after surgery, as you prefer. For the first night, we prefer the leg slightly bent, on a pillow, since this reduces bleeding in the knee. The head of the bed can be in any position that you like.
You will have some sort of pump device squeezing your feet or legs to reduce the chance of a blood clot. You should exercise your calf and ankles regularly after surgery while you are awake. This will cut down the risk of a blood clot.
Right after surgery, avoid eating solid foods. It is better to start with liquids, and make sure that you can handle these before you progress to a full diet. Nausea is a very common side effect of modern pain medications.
Mechanical foot pumps are used to squeeze the feet and ankles intermittently after surgery in order to help reduce the chances of a blood clot forming. These are useful while you will be in bed and resting. We use them while you are in the hospital; you will not use them at home.
Typically, patients have little to no pain, but nausea is more common. This nausea can come from the anesthetic drugs or from pain medicines and we can help control it by changing pain medicines and prescribing anti-nausea agents if necessary. If you have pain, nausea, or any other disagreeable sensation, let the nursing staff know. They are very knowledgeable in controlling such symptoms. Usually, an adjustment of medications is all that it takes.
Yes. A combination of unfamiliar surroundings, surgery on the leg, narcotic medications, nerve blocks used to control pain, and the effects of anesthetic drugs can increase the risk of falling.
To avoid a fall in the hospital and after discharge, use a walker when out of bed, even if you feel that the knee feels fine and will hold you up. If in doubt, ask the nurse or therapist for assistance.