Reading the information on this site, communicating with your surgical team, and paying close attention to the checklists will best help you prepare for knee replacement surgery. The importance of preparation and information to successful surgery cannot be overemphasized.
Some patients have unusual problems, such as HIV infection, hemophilia, cancer, bleeding disorders, liver or kidney transplants, enzyme disorders, and other conditions that require specialty consultations before surgery. If these considerations apply to you, we will work with you to obtain the necessary testing and treatment prior to surgery.
Pre-surgical checks are essential for your safety and it is unwise to short-circuit them; they are comparable to pre-flight checks that every responsible pilot makes before taking off. Out-of-town patients, or those traveling long distances, can have local doctors perform these checks; we will work with your doctors to expedite this. The necessary pre-surgical checks are listed below.
Medical Check: Prior to your surgery, you should see an internal medicine specialist to identify and manage your health risks. Examples of increased risks are heart and lung disease, tooth and gum disease, infection, obesity, and diabetes. That is why patients should undergo testing and clearance by a medical doctor prior to knee replacement surgery.
Dental Check: A dental check-up is necessary to identify any hidden infection in your teeth or gums. Such infections must be treated before knee replacement to eliminate the risk that bacteria from decayed teeth enter the bloodstream and end up infecting the knee implants. If you are traveling from out of town, visit your dentist and forward us the information.
Heart Check: If there is any reasonable suspicion of heart disease based on your history, it is best to find out ahead of time if your heart is healthy enough for knee replacement surgery. Heart disease is usually silent; patients do not have symptoms until the heart is stressed. If indicated, we will have you see a cardiologist before surgery for clearance.
Pre-existing trouble with constipation usually leads to constipation and related problems after knee replacement. If you regularly take supplements to encourage bowel movements, let us know and we will plan accordingly, since the medicines we use during and after surgery can result in serious constipation.
You will be given a stool softener before surgery to avoid problems with constipation later. Even so, you can probably expect disturbance of bowel patterns and at least some degree of constipation after knee replacement surgery.
Blood glucose levels over 200 will lead to poor wound healing and increased risk of infection. Therefore, it is critical that your diabetes is under control prior to surgery. A medical consultation and lab data before surgery will help us ensure your diabetes is controlled and your surgical risk is minimized.
No. If bone has severe osteoporosis, it may not be possible for us to use an un-cemented prosthesis. However, the cemented version of total knees can be implanted in nearly every type of bone, including bone that has osteoporosis, and the outcomes are very successful.
Regular alcohol consumption should be disclosed to your anesthesiologist and surgeon ahead of time. Alcohol withdrawal can happen to anyone, regardless of economic or social background. When it happens, it can be life threatening and can complicate your recovery from surgery. If we know about alcohol consumption, we can take steps to avoid withdrawal. The same is true of recreational drugs. Be sure to talk about this with the anesthesia doctor.
Smoking increases the chance of lung complications during and after surgery, delays wound healing, increases the risk of complications after surgery, and increases the odds of residual knee pain even after successful knee replacement. Therefore, you should try to stop smoking, both for your general health, and to improve the odds of a successful result from knee replacement. Most hospitals are smoke-free, and you may not be able to smoke on the premises.
Obesity will increase the risk of complications from surgery, such as blood clots and slower wound healing. Ideally, your weight should be within reasonable limits before knee replacement surgery. In some cases, for excessively heavy patients, knee replacement is not an option without drastic weight reduction, such as with gastric bypass surgery.
That said, many people are somewhat overweight and unable to lose weight while dealing with a painful arthritic knee. The knee components are designed to handle enormous loads, and are safe, even in very heavy people. There is no evidence to suggest that the components loosen up prematurely, or wear out prematurely in heavy people.
Maintain a nutritionally sound diet including a variety of foods in preparation for surgery. Crash dieting is not necessary; rather, regular exercise will help control weight and improve overall health.
Exercise before surgery, done within reason, and within the capability of the patient, will improve the recovery from knee surgery. Therefore, a reasonable exercise program to strengthen your thigh and calf muscles before knee replacement surgery is the best thing you can do to speed up your recovery.
Exercising and strengthening the thigh and leg muscles before the operation will result in faster recovery and return to function, with less suffering, struggle, depression, and mood swings. Consultation with a physical therapist before surgery can be very useful.
The reason exercise helps is that the knee, even if worn out, is a living joint. Living tissues respond positively to physiologic stress, and exercise is known to improve self-perception, esteem, and outlook.
About a week or so before surgery, you will visit the pre-op department in the hospital. This visit is to read and sign consents for the surgery, for the anesthesia, and for blood products (if needed). You will have lab tests, possibly a chest X-ray, and an electrocardiogram. Please make a list of your medications and their dosages prior to this visit.
At this visit, you will be instructed on where to report on the morning of surgery. You will receive instructions on not eating or drinking after midnight the night before your surgery. This includes chewing gum and hard candy.
Keep in mind that surgery schedules change often; this is why the exact timing of the operation is not known until the day before. If you have a special preference, such as being the first in the day, or last, or in between, simply let us know and we will do our best to accommodate.
The hospital will contact you a day before the surgery to tell you what time to arrive at the hospital. Surgery schedules tend to change, which is why most hospitals will confirm the exact surgery time only a day or so before the operation. Please arrive early. The actual operation will usually be less than an hour in duration, but preparation takes much longer.
We have a program called “Joint Camp” that is designed to introduce you, in person, to the hospital and other resources, and to provide further education before your operation. You will get information on this program as part of the preparation, in case you decide to attend.
On the morning of your surgery, you will see an anesthesia doctor (anesthesiologist) who will have already reviewed your medical records. If your medical condition so requires, we will have consulted with the anesthesia doctor ahead of time. This doctor will inquire about your health and plan the anesthetic technique, including any regional nerve pain blocks. If you know of a particular anesthesiologist at the hospital whom you would prefer to provide this service, simply let us know ahead of time.
No. This is not necessary since not everyone needs a blood transfusion after knee replacement. If you have religious convictions against blood products, let us know and we can arrange to recycle your own blood. Blood loss differs from patient to patient, and pre-existing conditions such as anemia and other diseases can affect the odds of needing blood after surgery.
As a general rule, major bone surgery is associated with blood loss, but it is impossible to say how much blood a particular patient will lose. If needed, blood transfusions today are very safe and effective.
If you live alone, an adult friend or relative should stay with you, in addition to the home health nurse visits during the week. For very elderly patients and patients with other health problems, a stay in a rehabilitation unit or a nursing facility may be necessary.
You might consider local home health agencies prior to coming to the hospital. If you have private insurance, you will need to make sure you choose a home health agency contracted with your insurance. The best time to do this is before you have surgery. We have the resources to arrange many of these things for you to ensure a smooth transition to your home.
You should plan on about two to four weeks, depending on your individual circumstances and available resources. During the first month, a home health nurse will visit you several times a week. Having someone with you can help with daily activities and chores, even though you will be able to walk and transfer yourself by the time you leave the hospital.
We have forms that allow you to get a temporary disabled parking placard. A permanent disabled placard is not necessary after knee surgery, since the new knee is designed to increase your mobility. Some patients need a few weeks or months of parking in disabled zones, and others do not. Let us know if you need help with this.
Prior to surgery it is a good idea to take a close look at your home environment to determine if it is “user friendly” for someone on crutches or a walker. Modifications and equipment needs can be addressed ahead of time to ease your return home.
Examine your home environment to see if it is user-friendly for crutches or a walker. Modifications and equipment needs often include the following:
Moving furniture to widen pathways and making sure doors open fully will make it easier for you to navigate with a walker or crutches. Bathroom doors are often too narrow to get through. Your physical therapist will instruct you in a safe technique to use.
Before surgery, we can prescribe medications that are non-narcotic and non-addictive. These typically include anti-inflammatory medications and some light narcotic pain medications.
Any addictive drugs, such as narcotic pain-killers, should be obtained from your primary care doctor before surgery. Your primary care doctor and surgical team should be aware of all your medications, especially narcotic medicines.
In consultation with anesthesia and the pre-surgical medical consult, we will advise you personally which medications to stop in anticipation of surgery, and when to stop. The following are some general guidelines:
No, and these should be stopped around 10 days before surgery. Vitamins, herbal supplements, and nutrition supplements can interact with the other medicines we use during surgery, and can lead to excessive bleeding during and after surgery. After knee replacement, patients usually take a blood thinner for around a month. You can resume taking vitamins, supplements, and alternative therapies once you are off the blood thinner.
The evening before surgery take a shower, but avoid shaving the legs, since this increases the bacterial load.
For your hospital stay, pack a bag with a robe or housecoat that opens in the front; house shoes or comfortable shoes for physical therapy; personal hygiene items; underclothing; glasses or contact lenses with case; dentures or partials with case; a case for hearing aid and spare battery; a walker if you have one; a C-Pap machine if you use one; loose fitting clothing to wear for physical therapy; advance directive if you have one; a list of current medications with dosages; an inhaler if you use one; and reading material, cell phone, and laptop computer if you prefer. The hospital has wireless Internet for your use.
You should take your blood pressure and heart medications with just a sip of water the morning of surgery. Your medical doctor may advise differently; if so, please follow his or her instructions and provide us with this information. For example, in some patients, warfarin may be an essential medication safeguarding against stroke. In that case, we would work with the medical doctor to continue this drug, and alter our surgical preparation accordingly.
The pre-operative visit to the hospital is a good time to take notes and ask questions. Each patient is different; we customize our procedures and planning to your individual needs.
If you have an unexpected health problem, it may be safest to postpone the surgery until the situation is addressed. Let us know if you have any of the following close to your scheduled surgery: symptoms of a cold or flu (chills, fever, or a cough); pain, burning or frequency when you urinate; cuts, scratches, rashes, bug bites, non-healing sores on your skin; new swelling on the leg undergoing surgery; or a change in your medical condition, such as high blood sugar or chest pain. These situations could mean that surgery has to be rescheduled.