Knee Replacement Surgery

Day of Surgery

Before surgery/preoperative area:

• Upon checking in, you will be directed to the surgical preparation area. Your support person may stay with you during this time. You are in this area for approximately two hours.
• Your nurse will review your health history and medications.
• A technician may draw your blood.
• We encourage you to walk in the hall before surgery. This promotes circulation and helps prevent blood clots.
• A nurse will review the pain scale with you.
• A respiratory care technician or a nurse will show you how to use an incentive spirometer, which will help prevent pneumonia.
• Your support person will be directed to the waiting lounge, where they will be kept informed of your progress. They also are given a pager so they can be contacted without having to stay in the lounge. They are also given your assigned number to follow on the tracking board in the waiting lounge.
• A nurse will start an IV for fluids and medications.
• An anesthesiologist and your surgeon will talk with you.
• An anesthesiologist may insert the epidural or a femoral nerve block.
• The surgeon will mark where you will be having surgery.

In surgery

• A staff member will apply small EKG electrodes on the back of your shoulders and on your sides to monitor your heart rhythm.
• You will either have spinal, epidural, femoral nerve block, general anesthesia or combination of a spinal with a femoral nerve block.
• A staff member will perform a sterile scrub of your knee to reduce the chance of an infection after surgery.
• A nurse will insert a urinary catheter.
• Surgery lasts about 1-2 hours.

In the recovery room

• After your surgery, you will be in the recovery for 1-2 hours. You will probably awaken slowly as your nurse constantly monitors your progress.
• To help prevent swelling, promote circulation and decrease the chance for blood clots, you will have special stockings, wraps and compression devices on your legs.
• You will have ice bags over your knee to help prevent swelling and decrease pain.
• You will have a drain from the knee area.
• You may have oxygen in your nose.
• You may have a pulse oximeter on your finger, which measures how much oxygen is flowing in your blood and measures your heart rate.
• You may have a pain-control device.
• A nurse will draw your blood for testing.
• An X-ray will be taken.

In your hospital room

• Nursing staff will monitor your temperature, blood pressure, pulses, breathing, level of pain and circulation frequently.
• You will be offered ice chips and/or water. The afternoon or evening of surgery you, will be given a clear liquid diet (ex., Jell-O, juice and broth).
• Your nurse will remind you to use the incentive spirometer every hour while you are awake.
• If you have a pain pump, a nurse will show you how to use it.
• Your surgeon may order additional equipment for your leg, such as an immobilizer or a CPM (continuous passive motion) machine.
• A nurse will remind you to do your ankle, quadricep and gluteal exercises.
• Depending on your surgeon’s orders, you will be assisted in getting up in the evening, either to the side of the bed or into a rocking chair.
• Your surgeon may order for you to start physical therapy in the afternoon.

Day 1 after Surgery

• A technician will draw blood early in the morning so the results are available when your surgeon or physician's assistant makes rounds.
• You may receive a blood transfusion.
• The following may be removed: catheter, epidural, femoral nerve block, drain, IV fluids, patient controlled analgesia pump and oxygen.
• Your IV and medications will continue.
• You may eat and drink as you wish, unless you are on a special diet or nauseated.
• You will have a sponge bath and will be encouraged to provide as much of your own care as possible.
• Physical therapy starts in the morning. You will be assisted in getting up to a chair.
• You will have an afternoon physical therapy session and will be assisted in getting up to the chair again.
• You may sit for one hour at a time. If you wish to sit up longer you may, but you will have to use your call light to get assistance with standing, repositioning and sitting back down.
• You will be assisted getting back into bed.
• If your surgeon ordered a CPM machine or immobilizer, it will be on at night and off during the day.
• If your surgeon ordered a CPM machine, it will be on while in bed as often as tolerated.
• Your nurse will teach you about your medications.
• The care facilitator will discuss discharge plans with you.

Day 2+ after Surgery

Day 2 after Surgery

Your care will continue as on the first day after surgery, with the following additions:

• The following will be removed: catheter, epidural, femoral nerve block, drain, IV fluids, patient controlled analgesia pump and oxygen. You will then be able to wear your own clothes.
• Your surgeon or physician's assistant will remove your surgical dressing.
• You will now need to ask your nurse for pain pills. Take pain medicine with food or milk about 30-60 minutes prior to therapy and as needed. Taking pain medication before activities helps relax your muscles and increases your ability to complete your therapy. Let your nurse know if your pain is not controlled.
• Physical therapy will continue this morning. You will have physical therapy twice a day Monday-Saturday and once on Sunday. You will learn transfer techniques and begin walking with assistance.
• You will have occupational therapy to assist you with activities such as bathing and getting dressed and to evaluate your need for any home equipment.
• The care facilitator will review your discharge plan, and you may be released.

Day 3 after Surgery

Your care will continue as on the first days after surgery, with the following additions:

• You will have physical and occupational therapy and may climb stairs, and you will take a shower.
• If you have not had a bowel movement by this time, ask for a laxative or stool softener.
• You will most likely be discharged.

Day 4 after Surgery

Your care will continue as on the first days after surgery, with the following additions:

• If you have not climbed stairs, you will before you go home.
• Your physical or occupational therapist may ask a family member to observe your therapy sessions so they can assist you.
• Your nurse will review activities, incision care, medications, restrictions and doctor appointments with you.
• You will receive written discharge instructions.