Knee Replacement Surgery

Knee replacement surgery removes a diseased knee joint and replaces it with an artificial joint, called a prosthesis. These implants are made to resist corrosion, degradation and wear. Knee replacement is typically used for people with severe joint damage from arthritis or an injury. Followed by rehabilitation, knee replacement can relieve pain, restore range of motion and mobility and in many cases lead to an overall increase in the quality of life.
 
Preparing for your knee replacement surgery
Because your joint replacement is usually a scheduled surgery rather than an emergency, you’ll have time to prepare for the surgery and recovery period. Riverside offers classes and services to help you get ready so you’ll have a worry-free surgery and rehabilitation.
 
Here are some tips to make your recovery a more positive experience:
 
Riverside joint replacement classes
Knee replacement is major surgery. Our Joint Replacement Class fully prepares you for the surgery and afterwards. To help alleviate surgery jitters, our staff walks you through what you can expect from surgery and rehabilitation. We’ll show you exercises that will strengthen your muscles, which will speed your recovery. You’ll learn what equipment you’ll need post-surgery and how to get your house set up for your recovery period. We’ll also cover the rehabilitation programs at the Riverside Rehab Centers as well as what you should expect in terms of pain management, time on crutches or a walker, length of physical therapy, type of home assistance required, and time until you can resume full activities
 
Riverside home health care visit
Because the recovery period you spend in your home is so essential to your healing, Riverside offers a unique, free home health care visit. With this service, a nurse will come to your house, at no charge to you, and review with you and your family how to make it comfortable and rehab-friendly. You won’t be a victim of “if only I had thought of that” while you heal. For instance, our expert may point out something as simple as rugs that need to be moved to prevent tripping or slipping.  Or, you may be advised on what type of bed or other medical equipment to acquire for the recovery period. To schedule your free home visit, call (757) 594-5600.
 
Riverside tips
We have few tips of things you will want to take care of before your surgery to reduce worries and to make life more convenient while you are healing.
         
Make sure your medical insurance coverage in order
Insurance coverage is one area you don’t want to worry about. Well before the surgery, contact your insurer to make sure you understand the following:
  • Need for a second opinion on your knee replacement surgery.
  • Hospital and health care providers’ status as “in-network” or “preferred.”
  • Deductibles for hospital services.
  • Limits on length of stay.
  • Coverage for hospital rehabilitation services.
  • After-care services for your hip or knee replacement surgery, such as physical or occupational therapy. (Ask whether the therapists must be from an approved list and how many visits or sessions are covered.)
  • Equipment such as wheelchairs, walkers, and crutches, and whether they must be obtained from approved vendors.
  • Home health care coverage, what type, and for how long.
 
Get your home ready for recovery
After your surgery, your mobility and flexibility will be severely limited while you are recovering. Planning ahead can save aggravation and keep you safe.
  • Rearrange furniture to create wide walkways to accommodate a walker or crutches.
  • Remove rugs that may cause trips or slips.
  • Go through the house and place frequently used items within arm’s reach.
  • Make sure you have a sturdy chair with arms in the room where you will spend most of your time. Place a table, wastebasket, phone and TV remote control nearby.
  • A lightweight bag, like a cloth grocery bag, that you can put over your shoulder is convenient for carrying the phone or a book with you while you are on crutches or using the walker. Some people use a carpenter’s belt.
  • Set up a bedroom downstairs. You don’t want to attempt the stairs during this period.
  • Buy or prepare and freeze meals in advance.
  • Take care of important paperwork and get caught up on bills
  • Buy a long-handled grabbing device. You won’t be able to reach down or over to pick up things.
  • Consider buying an elevated toilet seat and a shower bench.
  • Consider installing handrails and grab bars in the bathroom and shower.
  • Ask neighbors, friends and family for help in advance.
  • Contact your Orthopaedic Surgeon’s office to sign up for the free visit from the home health care nurse. 
 
Medical preparations
  • Donate your blood. Because you may require a blood transfusion during or after your surgery, you may be asked to donate your own blood.
  • Pre-operative testing. You’ll need to go for Preoperative Assessment testing before your operation or on the day of your surgery. Call Riverside scheduling at (757) 989-8830.
  • Exercising. You’re getting a new knee, so it may sound counterintuitive to exercise and strengthen the one you’ve got now. However, it's essential that the muscles surrounding your new knee are strong enough to support you as you move, walk and to get in and out of bed after surgery. You’ll also need strong arms to help you sit down and pull yourself up. Riverside physical therapists will recommend specific exercises for you.
  • Nutrition. Your body needs to be in the best condition possible before the stresses of surgery.  This means you should try to lose weight if you are overweight. Everyone should eat a healthy, well balanced diet and increase your intake of calcium, iron and vitamin C. Calcium is important for building and maintaining bone strength. Iron builds red blood cells, which help healing. Vitamin C improves the absorption of iron into the body.
    • The Recommended Daily Allowance (RDA) of calcium is 1000 to 1200 milligrams a day.
    • The RDA for iron is 8-18 milligrams a day
    • The RDA for vitamin C is 75-90 milligrams a day
 
Other questions?
Your Riverside surgeon and staff will be happy to explain the hip or knee replacement procedure, the type of device being implanted, and what you should expect in terms of pain management, your rehabilitation center stay or the type of home assistance required.  Don’t hesitate to ask questions. The Riverside Nurse service is also a good resource for information about knee replacement surgery and recovery. They can be reached at (757) 595-6363.
 
The day before surgery
Do not have anything to eat or drink after midnight before your surgery. (This includes mints, chewing gum, coffee, tea or water.) Since you’ll be using anesthesia, it’s essential that your stomach is empty during surgery.
  • If you smoke, cut down or quit as soon as possible. Smoking changes blood flow patterns, delays healing and slows recovery. It's very important that you do not smoke after midnight before your surgery or the first 24 hours after. Please be advised that Riverside Regional Medical Center is a non-smoking hospital.
  • If you drink, do not consume any alcohol for at least 48 hours before surgery.
  • If you use any type of controlled substances, tell your doctor. Narcotics and other drugs can have an impact on your surgery.
  • Take a shower or bath the night before your surgery to help reduce the risk of infection.
  • Do not shave the area of your surgery.
  • Do not wear any make-up, lipstick or nail polish.
 
 
The Day of Surgery
 
What to bring
  • Low heeled walking shoes with non-skid soles or tennis shoes. No open heel shoes or clogs.
  • Pajamas and a short bathrobe.
  • Loose fitting, comfortable clothing wear when you get up and move after surgery.
  • Toilet articles and any other needed personal items.
  • Eyeglasses.
  • If you use an inhaler, please bring it.
  • Bring any orders given to you by your doctor and give them to the person who admits you.
  • Insurance card, driver’s license or other government issued-issued ID.
  • A list of your home medication including nonprescription or herbal items along with a list of :
    • For what condition do you take them
    • How often you take them (unless on the medication packaging)
    • Dosage
  • Do not bring your crutches or walker unless asked.
  • Leave all your valuables at home--money, jewelry and credit cards.
What to expect
Knee surgery requires a hospital stay. Riverside offers surgery on the same day you are admitted, so instead of spending the night before in the hospital, you can sleep in your own bed. You’ll be given instructions on food, medicine and liquid intake and told the time to come to the hospital.
 
Admission
  • At the hospital, you’ll take care of some hospital admission paperwork. Don’t forget to bring your insurance card and a driver’s license or other government-issued ID.
  • In the pre-surgery unit, a nurse will speak with you and verify your health history and allergies.
  • You’ll put on a gown and lay on a stretcher. From here on out, you’ll be wheeled to the various areas for your knee surgery and recovery.
  • Intravenous fluids will be started to provide you with medication and fluid during surgery and for a day or two after your operation.
  • You may receive medication to help you relax and dry out your mouth.
 
The Operation
The operation will take two to four hours. You’ll be given general, spinal, or epidural anesthesia. After you are anesthetized, the surgeon will make an incision in the skin over the knee and cut through the joint capsule. He or she must be careful in working around the tendons and ligaments inside the joint because the knee depends on the ligaments for stability. 

The next step is cutting away the damaged cartilage and bone at the ends of the femur and tibia. The surgeon reshapes the end of the femur to receive the femoral component, or shell, which is usually made of metal and attached with bone cement.

After the femoral part of the prosthesis has been attached, the surgeon inserts a metal component into the upper end of the tibia. Sometimes, this part is pressed rather than cemented in place. If it is a cement-less prosthesis, the metal will be coated or textured so that new bone will grow around the prosthesis and hold it in place. A plastic plate called a spacer is then attached to the metal component in the tibia. The plastic allows the femur and tibia to move smoothly against each other.

Lastly, another plastic component is glued to the rear of the patella, or kneecap. This second piece of plastic prevents friction between the kneecap and the other parts of the prosthesis. After all the parts of the prosthesis have been implanted, the surgeon will check them for proper positioning, make certain that the tendons and ligaments have not been damaged, wash out the incision with sterile saline solution, and close the incision. Source: Encyclopedia of Surgery
 
Recovery room
After the operation is over, you’ll be moved to the recovery room where specially trained nurses will continue to monitor your vital signs. Once your condition is stabilized, you’ll be moved to a hospital room where you’ll be given pain medication. Your family will be notified as soon as your operation is over. In your hospital room, nurses will continue to monitor your vital signs and knee dressing.
 
Orthopedic unit stay
During your time in the hospital, your orthopaedic surgeon, nurses and physical therapists will monitor your condition and progress closely.
  • You may be surprised how quickly after your surgery the nurses have you up and moving around.
  • It’s important after surgery to cough and breathe deeply to help your lungs remain clear.
  • You’ll also need to change positions with the help of a nurse about every 2-4 hours to help keep your skin and blood flow healthy.
 
Pain relief
Postoperative pain management enables you to do the required physical therapy and to minimize pain and stress. If a general or spinal anesthesia was used, postoperative pain relief may be delivered intravenously. You will be able to control the flow of medication, within preset limits as you feel the need for additional relief. Gradually the pain medication will be reduced and you’ll be given solid food.

Usually, you’ll be discharged once you meet rehabilitative milestones such as getting in and out of bed unassisted and walking a short distance.

 


 

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