1. How long will I be in the hospital?
The normal stay in the hospital after a total knee replacement is 3 days.
During that time you will be involved in an aggressive program of physical
therapy and nursing care. You will be up walking with assistance the day
after your surgery and will be sitting up on the side of the bed and possibly
in a chair the night of your surgery. It is important to get you up and moving
as soon as possible to decrease the chance of developing pneumonia or a blood
clot from lying in bed.
2. What will be done to decrease my risk of a ‘blood
clot’
otherwise known as deep venous thrombosis?
A blood clot or deep venous thrombosis is one of the most
common complications of knee replacement surgery. The great
majorities of these are minor and go undetected. To prevent
those that can cause serious complications we will place
special thigh high compressive socks called TEDs on the unoperated
leg before surgery and on both legs afterwards. In addition
we will use special foot pumps known as IPC to assist the
movement of blood in and out of your legs during and after
surgery. After surgery you will wear these pumps while in
bed or when sitting in a chair for along time. You will be
started on a medication called Lovenox after surgery. This
will be given to you in a shot form with a very small needle
twice a day while you are in the hospital. When you are discharged
from the hospital you may be required to continue to give
yourself these injections daily for ten days and then be
switched to a daily aspirin. The other option at the time
of discharge will be to take a daily medication by mouth
called coumadin which is a ‘blood
thinner’. The final decision of whether you will go home
on Lovenox injections or coumadin will be determined by your
primary care physician and me. You will also be sent home wearing
the special compression socks although the pumps will be discontinued
when you are discharged home.
3. How long will I be on crutches or a walker?
This depends on the type of knee replacement you have had. If the new knee
is cemented then you will usually be on crutches or a walker for two to three
weeks. You may possibly go to a cane before the end of this time. If your
knee is the type where the bone grows into the metal then you will be on
crutches or a walker for 6 weeks and will be required to limit the amount
of weight you place on the operated leg to 25 to 35 pounds. The physical
therapist will help you with this before you are discharged home.
4. How
soon can I drive a car?
Normally you can return to driving an automatic transmission
car when you can bend your knee 90 degrees or more and are
not requiring narcotic pain medications. This is usually
by two weeks after your surgery. Although, with the newer
surgical techniques we are using some are driving in a week.
5. Will I require outpatient therapy after my discharge from
the hospital?
Most patients require an additional three to six weeks of
therapy after discharge home. This is usually on a three
visit per week basis. The length of therapy after your knee
replacement will depend a great deal on how hard you work
during the sessions.
6. How soon after surgery will I be able to shower?
What will I need to do to take care of my wound?
By the time you are discharged home from the hospital you
will be able to either stand or sit in a shower. The nursing
staff will teach you how to protect your wound while bathing.
They will also instruct you in how to change your dressings
daily. They will remind you to watch out for new drainage
from the wound and to report this to my office.
7. Will I require blood transfusion with my surgery?
Blood replacement is often necessary with knee replacement
surgery. To reduce the risk of disease transmission through
a transfusion we can arrange for you to donate your own blood
for your surgery. This is arranged for you through my office
with the Red Cross Blood Bank. You may be required to donate
one or two units of blood depending on the type of knee surgery
planned. A special drain system may be used that allows for
the blood collected in the first 6 hours after surgery to
be given back to you through your IV site. If you are unable
to donate blood for surgery then we will use blood from the
Red Cross blood bank. The risk of HIV or AIDS from a blood
transfusion is 1 in 2 million, so the blood we do receive
from the Red Cross is as safe as is possible with today’s
technology in testing.
8. What will be done to decrease my chance of an infection?
You will be started on an antibiotic by IV before your surgery
and continued on this for at least 24 hours after surgery
depending on your medical condition and risks.
9. What are a CPM and an extension block, and why are they
necessary?
A continuous passive motion machine or CPM is a devise that
your leg is placed in and moves your knee for you. It can
be set to limit the amount of motion and the speed of the
motion. By moving your knee for you it decreases pain and
increases your return of motion to your knee after your knee
replacement surgery. The extension block is a large sponge
block device that your heel rests in and allows gravity to
straighten your knee out to full extension. It is used after
your knee replacement to help you get our knee out straight
in full extension. We usually limit its use to 2 to 4 times
a day for no longer than 20 minutes at a time.
10.
When will I be able to return to my daily routine and
activities? What sort of sports and activities will I
be able to do after a total knee replacement?
With the newer knee replacement techniques the return to
your daily activity schedule has been shortened dramatically.
Most patients are able to return to daily household activities
by 3 to 4 weeks. Activities requiring long periods of standing
or walking should not be undertaken until 6 to 10 weeks after
surgery. Although the incisions we are making are smaller
and the hospital time less a total knee replacement is still
a major stress to the body and it will take time to recover
and feel like your old self again. It is important to be
aware of how your body is reacting as you return activities
to your daily schedule. If your knee starts to ache or swell
that is a sign that you are at you limit and should stop,
ice, and elevate your leg for 10 to 20 minutes before proceeding
further. There are sports that are total knee friendly and
there are those that aren't’. Fast walking, walking,
bicycle riding, golf, horse back riding, swimming, bowling
are all total knee friendly. I don’t recommend running,
jumping sports, or sports that require a lot of twisting
such as tennis, racquetball, aggressive basketball, or downhill
snow skiing. If you have a question about a sport not mentioned
please ask before undertaking it. My goal is to make you
as active as possible with your new knee, but not to jeopardize
its function for the long term.
11. What is Minimally Invasive Knee Replacement surgery?
This is often misconceived as small incision surgery, but
actually is much more. MI surgery uses new approaches to
protecting the soft tissues (muscles, ligaments, and tendons)
to encourage faster recovery with less pain. The incision
used it smaller than the standard knee replacement incision,
but will very in length depending on the complexity of the
surgery.
I hope you have found this list of questions and answers
helpful. Please fill free to ask questions when you come
into discuss your knee surgery.
You
may find it helpful to make a written list of your questions
and bring this with you to your appointment. |
The
Most Common Total Knee Replacement Questions 
