Deal With and Recover From Complete Knee Replacement Surgery

Complete knee replacement surgery (or Total Knee Arthroplasty, aka TKA) is suggested when osteoarthritis, inflammatory arthritis, or (in the case of an old injury) traumatic arthritis causes debilitating pain, stiffness, swelling, and/or locking up in the knee joint to the point of limited function and a decreased quality of life. Making the decision to have the surgery requires you to weigh the pain and discomfort of your existing condition against the risks of surgery and the long recovery period needed to regain most or all of your mobility. While the recovery procedure varies throughout the country and the world, and from person to person, this article might help you prepare and know what to expect.

Steps

 * 1)  Maintain a robust red cell count. About a month before the surgery, your doctor may have you take supplemental iron to boost the hemoglobin in your blood system.
 * 2)  Attend pre-operative seminar if offered. This will explain what you will be going through while you are in the hospital and what to expect when you go home for recuperation.
 * 3)  Prepare your body before surgery. Post-surgery rehabilitation will be significantly easier if your muscles are stronger. Ask your doctor for exercises you can do at home to prepare, or consider working with a personal trainer or physical therapist.
 * 4)  Consider mind-body medicine such as guided imagery or meditation to prepare for the pain involved in rehabilitation and recovery.
 * 5)  Discuss with your health care provider about autologous blood donation--that is, donating your blood for your own use in case you lose too much blood during the surgery, about two weeks before the surgery.  Some surgeons use a bipolar sealing device that may reduce or eliminate the need for this step.
 * 6)  Make an appointment with your health care provider to have a pre-operative physical, about 10 days before the surgery. He or she will check your general health, order blood work, a chest x-ray, and other tests to determine if you are healthy enough for surgery.
 * 7)  Have a pre-operative exam with your surgeon, usually a day or two before the surgery. Last minute details will be discussed and you will be asked to sign some papers, including a consent form, where you will give permission for the surgeon to perform the knee replacement.
 * 8)  Arrive a couple hours before your scheduled time of surgery, on the day of the surgery, so that you can go through the admitting procedures and any last minute tests that may need to take place. The anesthesiologist will most likely stop by to review your history and to discuss anesthesia options with you. A catheter will be placed in your bladder so that you won't have to get out of bed to urinate during the first day. You will be in the recovery room for several hours before you are moved to your room. It will be suggested that you leave your valuables at home--your visitors can bring them later, if necessary, along with your toiletries and other personal things. Remember though, you will not be able to keep an eye on them every minute. You may not feel like doing much except resting during that first day.
 * 9)  Depending on how long you are in the recovery room, you may need pain medication as the anesthesia wears off. Don't be hesitant to ask for it.
 * 10)  When the nurses feel you are stable, they will request a room on an orthopedic or surgical floor and you will be transferred there after recovery.
 * 11)  Once you are in your room, you will probably be left alone for a while, though your vital signs will be taken frequently, and you will be asked about your need for pain medication. This is often assessed by asking you to rate your pain according to a particular scale.
 * 12) *You may be able to receive visitors, depending on the hospital's policy.
 * 13) *You sometimes will remain in bed for the whole day; however some surgeons have you at least stand up the first evening of your surgery day.
 * 14) *If you are up to it, you can have a meal, probably a liquid diet to begin with. Solid food is usually offered once bowel sounds are heard.
 * 15) *You may be given anti-coagulants, such as heparin, to avoid blood clots in the surgical leg. Likewise, you will probably be given compression hose and/or "leg squeezers" (leggings with alternating on/off air pump) which also help to prevent blood clots.
 * 16) * Your surgical leg may or may not be placed on a continuous passive motion (CPM) machine, depending on your doctor’s orders and whether it is covered by your health insurance policy. The purpose of the CPM machine is to start your knee moving before you're out of bed, to decrease stiffness, and to prevent the development of scar tissue.
 * 17) *Some hospital settings allow for the self-administration of pain medication through an IV pump. This is called patient-controlled analgesia (PCA). When you have pain, you can give yourself medication through the PCA pump by pushing a button. The machine will not allow you to give yourself more than a pre-programmed amount so that you cannot overdose.
 * 18) *If you are having a hard time sleeping, ask for a sleeping pill.
 * 19)  On the second day, your vital signs will be taken, your blood will be drawn, the catheter will be removed, you will be assisted out of bed, and physical therapy will be started. You will most likely start by simply sitting in a chair for a while. In most settings, you will be shown how to take a shower, either with or without accompaniment.
 * 20) * The physical therapist will teach you how to get out of bed using the log-roll maneuver, which will allow you to get out of bed without putting much stress on your knee. He or she will then teach you how to use a walker. On the first session, you may only walk 10 feet before returning to your bed or chair. Sitting in a comfortable chair is an encouraged alternative to lying in bed that helps with your lung function and circulation.
 * 21)  On the third day you may have physical therapy several times. You might walk two to three times as far as the previous session. Pain medication may make walking (with assistance) easier and less painful. Keep in mind that more mobility brings increased circulation and faster healing. Use the CPM machine according to your doctor's instructions.
 * 22)  Depending on your condition, you may be discharged on the fourth day. Prescriptions need to be written, morning medications need to be administered, and other check-out procedures will take place. From the time your doctor writes the order for your discharge until the time you leave may be a few hours. Have clothing handy; make sure your pants will fit over a swollen knee. Your doctor will give you prescriptions for medication that can be filled at a local pharmacy--a family member can do that once you are resting comfortably at home. These prescriptions are for pain pills and other medications your doctor feels are necessary for your recovery.
 * 23) * Getting in the car can be difficult since the knee will be very stiff. Have the seat slid back as for as possible and the back rest folded down, so that you can move your buttocks as far away from the door jamb as possible. Once inside, you can reposition the seat back to the normal position.  Alternatively, you can slide in buttocks-first into a rear seat and keep your leg elevated for the ride home.
 * 24) *If you have no caregivers at your house who can help, you may be able to go to an extended care facility after the hospital discharge. This will give you more time to recuperate, so when you do go home you can tend to yourself more easily.
 * 25)  On your first day home, try to rest intermittently throughout the day. When you feel rested, that is a good time to do the exercises you were shown by the hospital physical therapist. If your insurance company provides you with a home CPM machine, use it according to your doctor's discharge instructions. This will leave you little time for anything else, except perhaps a good book or TV.
 * 26)  Again, depending on your doctor and your insurance company, you may receive physical therapy at home. If the insurance company does not pay for physical therapy, consider paying for it yourself to minimize the chance of complications. You will need to set up session times with the therapist. The sessions will help you recover faster and more completely.
 * 27)  After using the walker, you will probably graduate to walking with a cane. Practice walking in a level and safe location and have someone with you during your first walks with the cane.  If you have stairs in your home, the physical therapist at the hospital will have instructed you on the use of crutches, and will have tested your ability to negotiate stairs independently with your crutches.  If you cannot manage the stairs with crutches, it's best to stay on a single floor, setting up a bed and bedside commode in a living room, for example.
 * 28) * Walking with a cane gives you much more freedom. Remember to keep the cane in the opposite hand from the surgical knee. When going up or down stairs, remember the surgical leg goes down first and the other leg goes up first.
 * 29)  When you are able to get around in the community and there are no more barriers at home, it makes sense to seek a good physical therapist in a convenient location. Being able to drive will depend on a number of factors, such as the frequency of pain medication, whether your car is an automatic or stick shift, and which knee was replaced.

Tips

 * Pain is best kept at bay by taking medication before the pain becomes unbearable. For example, if you have Percocet ordered for every 3 hours, try to take it every 3 hours--there's no reason to hold out for as long as you can stand it, at least for the first day or two.
 * You might want to have a discussion with your nighttime nurse about whether you want to be woken up for your pain medication.
 * When you have to move your new knee off or onto a bed, use your good leg to support and lift it. In a few weeks, you will no longer need to do this.
 * Consider taking pain medication about an hour before you are scheduled for therapy to make it easier to tolerate the painful stretching that is necessary to recover properly from total knee replacement.
 * Use a spare bedroom if possible for your physical therapy and/or CPM machine. That way you won’t have to move the CPM machine on and off the bed every night.
 * Think of all the things you can do before your surgery to make life less complicated afterward. Some doctors will give their patients a prescription beforehand for the pain medication needed at home--this way, you won't have to stop on the way home from the hospital and wait for a prescription to be filled. If you're able to cook or go grocery shopping, consider stocking your freezer with microwavable meals. Line up some friends to check in on you, run errands for you, walk with you, or simply provide some company. Remember, most everyone appreciates the opportunity to help a friend, though most of us have trouble asking for that help.
 * Narcotics frequently cause constipation, so having your favorite remedy at home might be one of the nicest things you can do for yourself. You will probably be given medication for this while you're in the hospital.
 * Most hospitals will not require you to wear a hospital gown during your stay. You might feel more comfortable in your own clothes, particularly since you will frequently be out in the hall walking--loose clothing with an elastic waist, or shorts, make the most sense. You will appreciate shoes that you can put on without bending.
 * Clip your toenails the day before your surgery. Wash your hair the night before or the morning of your surgery.
 * If you don't have a stationary bike at home, ask around to see if you can borrow one while you're recovering, once you have the OK from your surgeon. An exercise peddler is a less expensive and convenient alternative to a stationary bike.
 * If you have a choice of hospitals, consider one that has achieved Magnet status, an indicator of nursing excellence.
 * To find a qualified physical therapist to assist in recovery following total knee surgery, consider visiting the website of The American Physcial Therapy Association. They have a section called "Find a PT" where you can look for therapists in your area with expertise in orthopedics. Therapists with the intials "OCS" have been certified by this national organization as having a particular level of expertise in the field of orthopedic injuries and in surgeries such as TKA's.

Warnings

 * This is a significant surgery with a painful recovery period. Do not let a fear of pain prevent you from having the surgery.  The pain is tolerable and can be managed with medication.  The end result is well worth the pain of the recovery.
 * Knee replacement surgery may lengthen or shorten the limb creating or exacerbating (or fixing) a leg-length discrepancy.
 * Choose the surgeon and the physical therapist carefully. Consider a surgeon who utilizes Computer Aided Surgery to better align the prosthesis and aide in making the all important saw cuts on your femur and tibia.
 * Knee prostheses may contain nickel. Some people are allergic to this element. Discuss this with your surgeon; there are prostheses made of zirconium.
 * To avoid unexpected expenses, check with your insurance company before undergoing the surgery, so you know going into it exactly what your policy covers, including deductibles, copays, and the number of therapy visits covered.

Related Tips and Steps

 * How to Prepare for Surgery
 * How to Find a Doctor
 * How to Describe Medical Symptoms to Your Doctor
 * How to Summarize Your Own Medical History
 * How to Handle Excruciating Pain