Guidelines for Pre- and Post-Operative Care for Knee Surgery

What to Expect on Surgery Day

Knee Condition and Mobility

Once you’ve had knee replacement surgery and completed rehab, your knee should have a range of motion of 100-120 degrees, sufficient for all your daily tasks such as walking and climbing stairs.

Thanks to your new knee, you will be able to do many of the activities you did before your knee surgery, but with little or no pain. Most people with total knees can do recreational walking, swimming, golf, driving, light hiking, recreational biking, ballroom dancing, and stair climbing without difficulty.

Activities to Avoid

Even though your activity level is likely to increase, a knee replacement surgery means that high-demand or high-impact activities must be avoided. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.

You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional), because it places very little stress on the knee joint.

How Long Your Implant Should Last

The average total knee currently lasts 10-15 years before the components wear out. In some cases, worn components can be easily switched out for new ones, but revision surgery is always an experience doctors and patients want to avoid if at all possible.

Knee surgery has great potential to improve your quality of life and ensure that you can remain active and vital.

Sometimes a knee replacement is the only option for reducing pain and restoring a normal activity level. If your doctor decides that knee surgery is right for you, here is an idea of what to expect during the days leading up to and the day of your surgery.

Pre-Surgery Routines

Once you and your orthopaedic surgeon have decided to proceed with knee replacement surgery, there are several activities that must occur to help make sure all goes well.

First you will have your initial surgical consultation, which will include preoperative X-rays, a complete past medical history, a complete past surgical history, and a complete list of all medications and allergies. This consultation will also include orthopaedic examination and discussion of the knee replacement surgery procedure.

Next you will have a complete physical examination. Your internist or family physician will determine if you are in the best possible condition to undergo knee surgery.

You may wish to donate blood prior to your knee replacement surgery in the event that a transfusion is required after surgery.

Your doctor may recommend that you see a physical therapist before surgery to learn exercises to begin prior to surgery. You will also get an overview of the rehabilitation process after knee replacement surgery. This will prepare you better for your post-operative care.

Preparation for the Hospital

You may want to bring the following items to the hospital for your knee replacement surgery:

  • Clothing: underwear, socks, t-shirts, exercise shorts for rehabilitation
  • Footwear: walking or tennis shoes for rehab, slippers for hospital room
  • Walking aids: walker, cane, wheelchair, or crutches if used prior to surgery
  • Insurance information

The evening before surgery you should not eat or drink after midnight. Your surgeon may provide you with special soap. You should shower and use this soap to scrub the surgical area for five minutes, or as long as prescribed. Prepare your belongings for the hospital, relax, and get a good night’s rest before your surgery day.

Preoperative Procedures

On the morning of your knee replacement surgery you will be admitted to the hospital. Your vital signs will be taken, you’ll be given a clean hospital gown to wear during the procedure, and an IV will be started to give you fluids and medication during and after the procedure.

You may be provided an elastic stocking to decrease the likelihood of blood clots. You will be asked to empty your bladder. All jewelry, dentures, contacts, and nail polish must be removed. The surgical leg will be scrubbed and shaved in preparation for surgery. The anesthesiologist will come into your room and discuss the type of anesthesia that will be used. Finally, you will be taken into the operating room.

Surgery and Recovery

A total knee replacement involves cutting away the damaged bone of the knee joint and replacing it with a prosthesis. You will be under anesthesia during the procedure.

After your surgery is completed, you will be transported to the recovery room for close observation of your vital signs, circulation, and sensation in your legs and feet. As soon as you awaken and your condition is stabilized, you will be transferred to your room.

Your doctor may prescribe a PCA device (patient-controlled analgesia) that is connected to your IV. The unit is set to deliver a small, controlled flow of pain medication and is activated when you firmly press the button on your machine. Press the button anytime you are having pain.

You may have a catheter inserted into your bladder as the side effects of anesthesia may make it difficult to urinate.

A continuous passive motion (CPM) unit may be placed on your leg to slowly and gently bend and straighten your knee. This device, if prescribed, is important for quickly regaining your knee range of motion.

In a small percentage of people, as with all major surgical procedures, knee replacement complications can occur. Below is a list of potential knee replacement complications and steps you can take to prevent their occurrence.

Thrombophlebitis

This condition is also known as deep vein thrombosis (DVT), and it occurs when the large veins of the leg form blood clots and, in some instances, become lodged in the capillaries of the lung and cause a pulmonary embolism. The following steps may be taken to avoid knee replacement complications due to blood clots:

  • Blood-thinning medication (anticoagulants)
  • Elastic stockings (TED hose)
  • Foot and ankle exercises to increase blood flow and enhance venous return in the lower leg.

IMPORTANT: If you develop swelling, redness, pain, and/or tenderness in the calf muscle, report these symptoms to your orthopaedic surgeon or internist immediately.

Infection

Although great precaution is taken before, during, and after surgery, infections do occur in a small percentage of patients following knee replacement surgery. Steps you can take to minimize this knee replacement complication include the following:

  • Monitor your incision closely and immediately report any redness, swelling, tenderness, increased drainage, foul odor, persistent fever above 100.4 degrees orally, and increasing pain.
  • Take your antibiotics as directed and complete the recommended dosage duration.
  • Strictly follow the incision care guidelines your surgeon recommends.

Pneumonia

Because your lungs tend to become “lazy” as a result of the anesthesia, secretions may pool at the base of your lungs, which may lead to lung congestion or pneumonia. The following steps may be taken to minimize this complication:

  • Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to, “smell the roses and blow out the candles.” In other words, inhale through your nose, and exhale through your mouth at a slow and controlled rate.
  • Incentive spirometer: This simple device gives you visual feedback while you perform your deep breathing exercises. Your nurse or respiratory therapist will demonstrate proper technique.

Knee Stiffness

In some cases, the mobility of your knee following surgery may be significantly restricted and you may develop a contracture in the joint that will cause stiffness during walking or other activities of daily living. The following steps must be taken to maximize your range of motion following surgery:

  • Strict adherence to the CPM protocol as prescribed by your surgeon
  • Early physical therapy (day 1 or 2) to begin range of motion exercises and walking program
  • Edema control to reduce swelling (ice, compression stocking, and elevation)
  • Adequate pain control so you can tolerate the rehabilitation regime