Frequently Asked Questions
- What is included in the pre-admission visit?
- How long will I be in surgery?
- How long will I be in the recovery room?
- Will I donate my own blood?
- I am concerned about infection after surgery. Do I receive antibiotics?
- Will I be on medication or receive treatment for prevention of blood clots?
- Will the implants be cemented?
- What will I have for pain management?
- Will I have some type of drain?
- When will I be out of bed?
- Do I have to wear a knee immobilizer and for how long?
- What do I need to bring with me to the hospital?
- How many days will I be in the hospital?
- Do I have to use a walker or can I use crutches?
- Upon discharge, will I go home?
- How do I prepare for my return home?
- When do I see the doctor after discharge?
At your pre-admission visit you will be registered for surgery. This will include lab tests such as blood work, and your doctor may order an EKG or a chest x-ray. Plan to spend approximately 1 1/2 to 3 hours in the pre-admission testing area.
The pre-admission nurse will review your medical history, current medications and inform you of any pre-surgery instructions from your doctor. The instructions to be followed will be specific to your needs. At this time, the nurse will also obtain your surgical permit. If you have an existing medical condition, you may need to consult your medical doctor for clearance that you are medically fit for surgery.
Anesthesia will review all of the information compiled by the pre-admission nurse and discuss your options for anesthesia and pain control. The anesthesiologist will work with your doctor to ensure your comfort after surgery. If at any time you experience more pain than you expect, please tell the nurses and your doctor.
Also, you will meet with an orthopaedic nurse. He/she will inform you as to what to expect during the hospital stay, review medications, discuss the surgery, and show pictures of equipment and rooms that will be utilized during your hospital stay. The nurse will also provide you with written information reviewing the surgery, and you will have the opportunity to ask any questions that you may have about post-operative concerns.
To the pre-admission visit, we strongly recommend you bring someone -- family or friend -- who will be assisting you after surgery.
Total joint replacement surgery typically lasts 1-2 hours. If your case may require longer, your doctor will have discussed this with you. If for some reason your surgery takes longer than anticipated, the operating room staff will be in contact with your family.
Recovery time in the Post Anesthesia Care Unit (PACU) is typically 1- 1 1/2 hours. If the PACU nurses feel you need further monitoring, they will keep you. The nurses will be in contact with your family to let them know of your progress.
Most patients do not require blood transfusions. Your doctor will have discussed or will discuss this with you.
You will receive a dose of antibiotics prior to the surgery and after surgery -- usually 3 or 4 doses are given in total.
All of the surgeons incorporate preventative measures to decrease the likelihood of developing a clot. This does not mean that you cannot develop a clot. Your doctor may order a tablet, a small injection, or devices such as stockings or wraps for your feet. A combination of these methods may also be used. Early ambulation is also important to decrease the likelihood of a blood clot, as well as performing the ankle exercises.
This is a decision made by your doctor. There are various reasons to cement or not cement. Your doctor will discuss this with you.
You, your doctor and the anesthesiologist will make this decision. There are several factors to be considered, and these will be discussed in your pre-admission visit. Pain from most total knee replacement surgeries is controlled by a continuous femoral block for 48 - 72 hours after surgery. Your anesthesiologist will place the femoral block catheter on the day of surgery. The nursing staff and your anesthesiologist will work to ensure a very good level of comfort, and together we will achieve control of the pain. Your pain is controlled as evidenced by the ability to rest and participate in activities. Staff will assess your level of pain control at regular intervals, so be sure to report any "new" or unrelieved pain. The goal is to solely utilize oral medications for pain control before you are discharged.
Usually, there are 2 types. One is a drainage system only that is removed after 24 to 36 hours. Another drain, which is called auto transfusion, collects the blood drainage for a specific time frame, and then the blood is delivered back to you. The type of drain used depends on the preference of your doctor and the amount of drainage expected.
That is a decision made by your doctor. Usually you will stand within 24 hours of the surgery. Physical therapy involves safely getting in and out of bed, learning how to safely move your knee, learning how to safely walk with the appropriate assistive device, and learning a variety of exercises to rebuild your muscle strength and endurance. Follow the directions of the nursing staff or therapy staff when getting in or out of bed. You may progress to only assistance as needed or even be able to get up on your own without staff assistance before discharge.
It is also encouraged that you intermittently sit in a chair. We do not want you staying in bed all the time. You are encouraged to reposition every 2-4 hours in bed, alternating between your back and your side. Let the nursing staff assist you to position your knee properly.
You will have some type of immobilizer for a few weeks after surgery to protect your new joint. Once your doctor has determined you have developed adequate strength in your leg, use of the immobilizer may be discontinued. However, you must remember your total knee precautions. Always follow the orders of your doctor.
Bring closed-toe shoes with a non-skid sole and a robe. Some patients prefer to stay in the hospital gown, some ladies prefer a long t-shirt or short gown, and some men prefer shorts or pajamas. Keep in mind that you are here for surgery and to begin the healing process. We want you to be comfortable.
The normal hospital stay for total joint replacement is 3 days. This consists of your surgery day and additional 2-3 days. If there is a medical necessity for an additional day, your doctor will work with your discharge planner and your insurance provider. Your discharge planner and case manager will work with you, your doctor and your insurance provider to meet your needs while in the hospital. If you should need additional medical equipment for your return home, they will help you obtain the necessary equipment. The discharge planner and case manager will also make arrangements for continuation of your physical therapy upon discharge.
Physical therapists as well as the orthopaedic staff prefer you use a walker. A walker has four legs and is more stable than crutches. Thus, a higher level of stability will equate to a higher level of protection to you and your new joint. If you have used crutches in the past and can use them well, you may be allowed to use them. If so, physical therapy will determine your stability with the crutches prior to discharge.
Each patient is different. There are several factors to consider when evaluating your ability to return home: age, living arrangements, and insurance are the three main factors. Some patients go home with home care services, others go home with therapy scheduled in an outpatient setting, and some may go to a rehabilitation facility. Your doctor will help to determine what is best for you.
Home preparations need to begin as soon as you schedule the surgery. Family, friends, and significant others who will assist you during this time are encouraged to be involved in making any changes in your home now to create a safer environment for you. Also, you need to arrange for assistance once you return home.
Safety concerns, needed equipment, and meal preparation should be addressed before admission for the surgery. Arrange for family or friends to be available on the expected day of discharge.
Equipment needs may include a shower bench, elevated toilet seat or commode, walker, crutches or a cane.
The Medical Center offers MedEquip, a home medical equipment service, that can help with any equipment you might need. You will need a firm chair with armrests to sit in after surgery, but one that keeps your hips higher than your knees will make it easier to stand until muscle strength returns.
Normally you will visit with your doctor within 2 weeks after discharge. At that time, the surgical staples are removed, and the doctor will review your need to continue total joint precautions and therapy. The doctor will also address any specific modifications to your normal daily activities including work-related concerns, so bring a list of questions and/or concerns.
The manufacturer of your new joint typically sends you a wallet card to identify the components used in the construction of the joint and any lifelong considerations such as antibiotics required before dental or medical procedures. Any doctor who provides care to you needs to be aware of your joint implant. Also, the implant may activate metal detectors, so an x-ray replica of the joint will also be made available to you to show as proof of the implant.