Your Total Knee Replacement What to Expect Before, During, and - PowerPoint PPT Presentation

Your Total Knee Replacement What to Expect Before, During, and After Surgery

Welcome! Pre-op Care and Hospital Stay and Instructions Surgery Details Post-op Care and Q&A Session Instructions

Before Your Knee Replacement

Preparing for Surgery ❖ Medical Evaluation ❖ EKG and Surgical clearance >60 years old – will need to see PCP (or ❖ Cardiologist) <60 years old – EKG done at pre-op at ❖ hospital Everyone – lab work and registration at ❖ Legent 15 days prior to surgery ❖ Assemble Your Medical and Personal Information

Preparing for Surgery: What YOU can do! ❖ Homecoming Preparation ❖ Cooking Preparation ❖ Getting the house ready ❖ Preparing for Your Hospital Stay ❖ Arrange for ride home ❖ What to bring Comfortable, loose-fitting clothes ❖ Copies of insurance, health directives, ❖ etc. Leave jewelry, cash, and other ❖ valuables at home ❖ Other Considerations ❖ Avoid alcohol use 48 hours before surgery ❖ Avoid/quit tobacco use

Before Surgery ❖ 3-7 days before surgery Stop blood thinners 7 days before ❖ Avoid shaving legs 3 days before ❖ Stop Metformin 2 days before ❖ ❖ 1 day before surgery ❖ Bath or shower using Hibiclens before bed ❖ Nothing to eat or drink after midnight ❖ Day of surgery May take medications in the morning with ❖ sips of water ❖ Arrival to hospital approximately 2-3 hours before start time

During Your Knee Replacement

Total Knee Replacement: Procedure Animation courtesy Visual Health Solutions, Inc.

Knee Replacement Surgery ❖ Anesthesia Considerations ❖ General anesthesia ❖ Regional nerve block ❖ Procedure Length ❖ Approximately 1-1.5 hours ❖ Antibiotics given during and while in hospital ❖ Hospital stay ❖ Typically 1 night in hospital

Your Knee Replacement: Type of Implant ❖ Stryker Triathlon Total Knee System ™︐ Specifications ❖ Femur component: Chrome Cobalt ❖ Tibial component: Chrome Cobalt ❖ Joint Spacer and Patella: Polyethylene ❖ Longevity ❖ 20-25 years ❖

Your Knee Replacement: Type of Implant ❖ Zimmer Persona Knee System ™︐ ❖ Specifications Femur component: tantalum ❖ Tibial component: tantalum ❖ Joint Spacer and Patella: Polyethylene ❖ ❖ Longevity 20-25 years ❖

Your Hospital Stay: Pain Management ❖ In the Hospital ❖ General Anesthesia ❖ Regional Nerve Block Typically last ~24 hours ❖ ❖ Pain medication - Oxycontin ❖ At time of discharge ❖ Norco (hydrocodone) – severe pain ❖ Tramadol-moderate pain ❖ Ibuprofen – as needed

Your Hospital Stay: Blood Clot Prevention ❖ During Hospital Stay ❖ Early walking and out of bed ❖ After Discharge from Hospital ❖ Aspirin 81 mg twice daily for 4 weeks ❖ Sequential Compression Devices (SCD) for high-risk patients (recommended for all) Can be purchased and be fitted before surgery ❖ Not covered by insurance ($225) ❖

Your Hospital Stay: Physical Therapy ❖ Day of Surgery and During Hospital Stay ❖ Out of bed and early walking ❖ Start using cane or walker ❖ After discharge ❖ Home physical therapy for approximately 3 weeks ❖ Outpatient therapy for approximately 10 weeks ❖ Home Exercise Program

After Your Knee Replacement

What to Expect: How Will Your Knee Be Different? ❖ Pain Relief ❖ 90-95% improvement in pain ❖ May still have some pain afterwards ❖ Improvement in function ❖ Able to do more of what you want to do ❖ Correction of deformities ❖ Improvement in range of motion ❖ Correction of varus deformity (bowed- legs)

Your Recovery: General Considerations ❖ Wound Care ❖ May shower 2 days after surgery, pat area dry and redress with dry dressing ❖ Look for any signs of infection ❖ Home nurse will instruct you in dressing changes ❖ After 3 week post-op visit, you will be able to shower, pat dry, and leave incision open to air ❖ Avoid lotions or creams for first 6 weeks ❖ Avoid submersing in bath, swimming pools, hot tubs, etc. for first 6 weeks

Your Recovery: Pain Management Example Pain Medication Regimen After Knee Replacement* Morning ❖ Norco (hydrocodone) for severe pain (6:00 AM) ❖ Tramadol/Ibuprofen for breakthrough pain ❖ Ice, elevation Noon ❖ Norco (hydrocodone) for severe pain (12:00 PM) ❖ Tramadol/Ibuprofen for breakthrough pain ❖ Ice, elevation Evening ❖ Norco (hydrocodone) for severe pain (6:00 PM) ❖ Tramadol/Ibuprofen for breakthrough pain ❖ Ice, elevation Night ❖ Norco (hydrocodone) for severe pain (10:00 PM) ❖ Tramadol/Ibuprofen for breakthrough pain ❖ Ice, elevation *may vary from patient to patient based on individual needs and physician recommendations

Your Recovery: Physical Therapy ❖ Physical Therapy ❖ Home Physical therapy for 3 weeks ❖ Transition to Outpatient Physical therapy for additional 10 weeks ❖ Focus on gradual walking program with improved range of motion and quad strengthening ❖ May include strengthening programs involving walking, water therapy, and stationary biking ❖ Your Activity ❖ Resume driving when your knee bends enough that you can enter and sit comfortably in your car Assess ability at 2-3 weeks ❖ Typically 4-6 weeks after surgery ❖ Do NOT drive if taking narcotic pain medication ❖ ❖ Use of cane or walker with walking for first 4 weeks

Your Recovery: Expected Milestones Day 1 ❖ Begin walking with cane/walker ❖ Being able to walk up/down 3 steps of stairs 3 weeks ❖ Walking with cane/walker – discontinue at 4 weeks ❖ Knee flexion to 90 degrees or greater 6 weeks ❖ Walking without cane/walker ❖ Knee flexion to greater than 100 degrees ❖ Full extension of the knee 10 weeks ❖ Walking and activity as tolerated ❖ Continue outpatient physical therapy ❖ Knee flexion to 110-120 degrees 3 months ❖ Completion of outpatient physical therapy, continue home exercise program ❖ Knee flexion to 120 degrees ❖ Walking and activity as tolerated 6 months ❖ Knee flexion to 120 or greater 1 year ❖ Return to normal activity level without restriction

Your Recovery: Avoiding Problems ❖ Preventing Infection ❖ Notify your surgeon before any dental work or procedures because antibiotics are needed to prevent infection ❖ Avoid all dental procedures for a minimum of 6 months after your surgery ❖ Typically take antibiotics 2 hours before any dental procedure

Your Recovery: Avoiding Problems ❖ Blood Clot Prevention Continuation of aspirin for 4 weeks ❖ Walking and activity ❖ Sequential compression device (SCD) ❖ Compression socks ❖ Foot and ankle exercises ❖

Your Recovery: Avoiding Problems Warning Signs of Infection Warning Signs of Blood Clot Increase pain in your calf ❖ Persistent fever ❖ Tenderness or redness above or below ❖ Shaking chills ❖ your knee Increased redness, tenderness, or swelling of the ❖ New or increasing swelling in your calf, ❖ knee wound ankle, and foot Drainage from knee wound ❖ Sudden shortness of breath ❖ Increasing knee pain with both activity and rest ❖ Sudden onset of chest pain ❖ Localized chest pain with coughing ❖ If you are experiencing ANY of these symptoms notify your doctor and go to the Emergency Room!

Thank You! If you have any further questions, please do not hesitate to call us or visit our website: (210) 545-7171 orthopedicperformance.com