Knee Replacement – Your Hospital Visit

In the morning before surgery, you can shower or bathe, brush your teeth, and shave. Do not eat or drink anything. However, follow your instructions about taking your daily medicine or pre-surgery medicine from the anesthesiologist. When you dress, do not wear makeup, jewelry, dentures, hair pins, contact lenses, or artificial limbs, if you use them. Your family can bring these to you later. Wear your elastic stockings if your surgeon has ordered them.

Most people are admitted to the hospital the morning of surgery. Follow the instructions given to you during your pre-admission visit about when to arrive at the hospital. The hospital will have the results of your pre-admission tests and all forms that you have completed.

Be sure to bring:

  • Your glasses, dentures, or hearing aid, if you use them.
  • A walker, if you have one.
  • Shoes with nonskid soles and a closed heel.
  • A knee-length robe.
  • Clothing that will be easy to put on and comfortable to wear home.
  • Any items you were asked to bring during your pre-admission visit.

At the hospital, someone will take you to a room or the surgical suite. A nurse will help you get ready for surgery and answer your last minute questions. You may be given medicine to make you a little drowsy and relaxed just before you are wheeled into the operating room. When you go to surgery, your family will be shown to a waiting area.

Your Surgery

Before surgery, an intravenous tube (IV) will be placed in your arm or the back of your hand. This tube supplies your body with necessary medicines and fluids. Also, you may begin receiving anesthesia through this tube. There will be other wires and tubes attached to or placed in your body. These help monitor your body’s functions, remove excess fluid, and help you breathe during surgery. Your knee area will be scrubbed with a germ killing soap. When everything is ready, the surgeon will begin by making an incision on the front of your knee.

A layer of bone on the end of the femur is replaced with a layer of metal (femoral component). The end of the tibia is replaced with a flat, metal tray-like device on which a strong plastic “wafer” (tibial component) sits. The back side of the kneecap may also be replaced with a thin plastic “button” (patellar button).

Your surgeon will test the joint by bending and straightening your new knee. An x-ray will be taken to make sure your knee is in the correct position. Your incision will be closed with stitches or staples. Then, your knee will be bandaged for protection and support, and kept slightly propped up to help circulation. Also, you may have a knee immobilizer. This is a device that protects your knee after surgery.

Your surgery will take about 2 to 3 hours. You will be in the recovery room for another hour or 2 for a total of 4 to 5 hours for surgery and recovery. Someone will let your family know when when you are taken to the recovery room. Your surgeon will update your family when your surgery is over.

In the Recovery Room

While in the recovery room, you will gradually wake up. You may feel groggy from the anesthesia. You will hear sounds from all of the equipment around you and your nurse telling you surgery is over. You will still have tubes and monitors attached. The monitors provide the recovery room nurses with data on how your body is recovering. Special pneumatic stockings (pulsatile type pumps) may be put on your feet and legs while your are in the recovery room. The pumps will massage your legs. You will be asked to “pedal” your feet up and down. The special stockings and the pedaling exercises will help prevent blood clots and help blood circulation. It is important to tell your nurse if you feel numbness, tingling, or pain in your feet and legs. If you need pain medicine, don’t wait too long to ask for it. It is easier to prevent pain than to stop pain. The recovery room nurses will keep a close watch on your recovery and help keep you comfortable.

Continuous Passive Motion (CPM)

Continuous Passive Motion (CPM) is passive motion done by a mechanical device that moves your knee joint for you continuously and slowly through a controlled range of motion. The passive motion helps speed healing on the tissues of your knee joint as well as other benefits.

Benefits of CPM

  • Prevents joint stiffness by keeping scar tissue and contractors from forming
  • Speeds healing of the ligaments and tendons
  • Helps the incision heal
  • Increases lubrication of the joint and speeds healing of the cartilage of the joint
  • Reduces pain after surgery
  • Gets your range of motion back more quickly
  • Allows you to be discharged sooner
Your surgeon may put the device on right after surgery while you are still under anesthesia and determine how much range of motion your knee has. The amount of motion is increased as often as you can tolerate it. How much time you are on the CPM everyday can range from 1 hour 3 times a day to 24 hours. Physical therapy is done during the periods you’re not on the machine.

On the Road to Recovery

Everyone’s recovery rate is different. How quickly you recover will depend, in part, on your physical health before surgery and how complex your knee surgery was. The hospital staff will continue your care by:

Surgery is only half the battle of getting a new knee joint — the other half is physical therapy. A physical therapist will work with you daily on getting out of bed and walking. It is very important that you get out of the bed as early as the day after surgery. The therapist will teach you exercises to strengthen your knee and leg. Exercise also helps blood circulation and prevents pressure sores. Your participation in the therapy sessions and exercises is a very important part of your recovery. You will begin the exercises in the hospital and continue them once you get home.

Before you go home, the hospital staff will teach you how to:

  • Get in and out of a bed and a chair.
  • Walk with crutches or a walker.
  • Get in and out of the shower.
  • Go up and down steps.
  • Get in and out of a car.

Taking Part in Your Recovery

As you become more active, you will become more involved in your recovery — even while you are in the hospital. You can:

  • Eat plenty of fiber and protein and drink plenty of fluids.
  • Get out of bed as soon as you can so your muscles stay strong; start slowly — sitting on the side of the bed, then the chair, then short walks, then longer walks.
  • Wear elastic or support stockings if your surgeon has ordered them.
  • Keep your lungs free of fluid by doing your deep breathing and coughing exercises.

Because of the anesthesia and your limited movement right after surgery, fluid can build up in your lungs. This fluid can lead to pneumonia which will keep you in the hospital longer. Therefore, it is important that you take deep breaths and cough several times each hour in order to keep fluids from building up. You may be given an incentive spirometer to help you breathe correctly.

When You’re Ready to Go Home

You can go home when you can bend your knee, your temperature is normal, you are able to get in and out of bed by yourself, and get to the bathroom by yourself. As you near the end of your hospital stay, you will be anxious to go home. Your mental outlook will improve and your physical recovery may speed up once you’re at home. Family, familiar surroundings, and peace and quiet can help a lot. Before you leave the hospital, your health care team will talk with you about:

  • How to care for your incision.
  • Wearing the knee immobilizer.
  • Using crutches or a walker.
  • A physical therapy program to do at home.
  • Special equipment recommended by your surgeon.
  • Supplies you will need.
  • When to make your first follow-up visit with your surgeon.
  • Medicines you will be taking.
  • Using the CPM machine at home.
Continuous passive motion machine for knee therapy

Continuous passive motion machine for knee therapy.

Before you go home, your physical therapist will watch you do your exercises to be sure you are doing them correctly. Ask your family to bring bed pillows for you to use in the car during your ride home. Your stitches or staples will be removed 10 to 14 days after your surgery. Do not get your incision wet until the stitches or staples are removed. Be sure to keep all follow-up appointments with your surgeon.

Total Knee Replacement

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