INSTRUCTONS FOR KNEE REPLACEMENT

BEFORE THE PROCEDURE:

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications. It may be necessary for you to stop these medications prior to the procedure.
• You will be asked to fast for eight hours before the procedure, generally after midnight. Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

• Based on your medical condition, your doctor may request other specific preparation.

DURING THE PROCEDURE:

Knee replacement requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practice.

Knee replacement surgery is most often performed while you are asleep under generalanesthesia. Your anesthesiologist will discuss this with you in advance.

Generally, knee replacement surgery follows this process:

• You will be asked to remove clothing and will be given a gown to wear.

• An intravenous (IV) line may be started in your arm or hand.

• You will be positioned on the operating table.

• A urinary catheter may be inserted.

• If there is excessive hair at the surgical site, it may be clipped off.

• The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

• The skin over the surgical site will be cleansed with an antiseptic solution.

• The doctor will make an incision in the knee area.

• The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis.

• The incision will be closed with stitches or surgical staples.

• A drain may be placed in the incision site to remove fluid.

• A sterile bandage or dressing will be applied. 

AFTER THE PROCEDURE IN THE HOSPITAL: 

After the surgery patients will be under observation till the time patient’s blood pressure, pulse and breathing are stable and patient is alert. Knee replacement surgery usually requires an in-hospital stay of several days.

During the hospital stay, you're encouraged to move your foot and ankle, which increases blood flow to your leg muscles and helps prevent swelling and blood clots. You might need to receive blood thinners and wear support hose or compression boots to further protect against swelling and clotting.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an
exercise plan to follow both in the hospital and after discharge. During the first few weeks after surgery, a good recovery is more likely if you follow all of your surgeon's instructions concerning wound care, diet and exercise. Your physical activity program needs to include:

• A graduated walking program — first indoors, then outdoors — to increase your mobility
• Slowly resuming other household activities, including walking up and down stairs

When you will be discharged home, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion. For several weeks after the procedure, you might need to use crutches or a walker. 

AT HOME:

• Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
• To help reduce swelling, you may be asked to elevate your leg or apply ice to the knee.
• Take a pain reliever for soreness as recommended by your doctor. Some Pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
• Notify your doctor to report any of the following:
• Fever
• Redness, swelling, bleeding, or other drainage from the incision site
• Increased pain around the incision site 

You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months. 

It is important that you avoid falls after your knee replacement surgery, because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve.

Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:

• Create a total living space on one floor since climbing stairs can be difficult.
• Install safety bars or a secure handrail in your shower or bath.
• Secure stairway handrails.
• Get a stable chair with a firm seat cushion and back, and a footstool to elevate your leg.
• Arrange for a toilet-seat riser with arms if you have a low toilet.
• Try a stable bench or chair for your shower.
• Remove loose rugs and cords.
• Avoiding stair-climbing until recommended by your doctor

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation. 

OUTCOMES:

HOW YOUR NEW KNEE IS DIFFERENT?

Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery. Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

PROTECTING YOUR KNEE REPLACEMENT:

After surgery, make sure you also do the following:

• Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
• Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
• Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
• See your orthopaedic surgeon periodically for a routine follow-up examination and x- rays, usually once a year.