Total Knee: Before and After TKR
Things To Do Before Total Knee Replacements Surgery
- Stop all aspirin and/or anti-inflammatory medications like Motrin, Advil, Aleve, Indocin, Feldene, Naprosyn, Clinoril and Relafen two weeks prior to surgery. The only anti-inflammatory medication that we allow patients to be on before surgery is Celebrex. Celebrex does not affect bleeding. Also, stop any herbal supplements that you are taking. Herbal supplements can affect not only bleeding but reactions to anesthesia. Tylenol is also an acceptable medication to take prior to surgery and does not affect bleeding.
- If you are taking any blood thinners like Coumadin, Trental, Persantine or Plavix, speak to your medical doctor about their use before surgery and the timing of stopping this medication. The longer you are off it the better and our anesthesia department requires at least two weeks off Plavix, Trental or Persantine prior to spinal anesthesia. For Coumadin we typically stop that medication 5-7 days prior to surgery and check your INR level the day before to make sure that it is safe for surgery.
- Discuss with your medical doctor whether to continue to take all of your other regular medication, like pills for your high blood pressure, heart and diabetes.
- We would recommend taking 1000 mg of vitamin C and a multivitamin low in vitamin E such as "Prenatal" vitamins daily for as long as possible before surgery. Other vitamin supplements that are available over-the-counter have an increased level of vitamin E and cause increased bleeding. If Dr. Bertram thinks based on your nutritional screen, which we perform before surgery, you may need a protein supplement and you can take one can of Ensure with each meal daily prior to surgery. Do this as long as possible before surgery.
- Report any infections that may develop before surgery immediately,
especially of the urine, skin or teeth.
- Be sure to arrange for added assistance for your return visit home and make plans to go home two days after the surgery. This will be the norm for 90% of the patients.
- Our patients typically do not donate blood prior to surgery. If you request this we can make arrangements but it is unusual that you would need a blood transfusion.
- Go for your preoperative teaching class at Naples Community Hospital that is available. It is an excellent class and will decrease your anxiety level about the surgery if you attend that.
- Do not eat or drink anything after midnight the night before surgery. Your surgeon or medical doctor may instruct you to take some of your medications with a sip of water the morning of surgery. Those will be explained to you in detail.
- Remove the following in preparation for surgery the night before: Makeup, nail polish, hair pins, jewelry, wedding rings, maybe tape the finger, hair pieces, dentures, eye glasses, contact lenses and hearing aids. We prefer that artificial nails be removed as well as they can harbor bacteria.
- Most patients will be admitted to the hospital the day of surgery.
The hospital staff will keep your clothes and toiletries you pack
for you. Please leave any valuables with a relative or friend.
- We would recommend that you obtain at the drug store a soap called Hibiclens and I would recommend that you shower with that your entire body including your peroneal area daily for one week prior to surgery.
- We would also recommend that you take DanActive yogurt drinks daily. If you are lactose intolerant there are other alternatives such as probiotics. Taking these will decrease your risk of developing an infection of the colon called C. difficile, which can be a significant and serious problem after surgery. This will also boost your immune system and help you to avoid infections after surgery.
We hope these things are helpful. We are hoping for the best possible outcome and we feel that by being proactive on some of these recommendations we have made will give us our best chance for success for your operations.
In the Hospital After Total Knee Replacement Surgery
You will be restricted to bedrest until the first day after surgery. You will be out of bed and into a chair the morning of the first day after surgery and then walking with your physical therapist.
You may require blood transfusion. This is unusual. Platelet gel will help to significantly decrease e the possibility of transfusion, but it cannot completely eliminate it.
Medications to expect – besides your regular medication that you took before the operation, a blood thinner of some form (this will either be Coumadin, Lovenox, or aspirin) will be given on a daily or a variable schedule. Intravenous antibiotics will be given for the first 24 hours. Pain medications will be given either through a special pump, by a shot, or by pills, and for the first 24-36 hours, you will have an epidural catheter in your back which will help to decrease your pain. This catheter will be removed in approximately 24-36 hours after surgery.
Blood samples will be drawn from you frequently so your surgeon can determine if you need a blood transfusion or any adjustments in your medications.
Use the special breathing machine and breathing exercises to clear your lungs to prevent pneumonia or a condition that is common called atelectasis
You will have pumps on your feet, and these pumps are very important and help to prevent blood clots, but it is important that you comply and wear these at all times while you are in bed. If you are in bed and they are not on your feet, call your nurse and have the nurse place them back on your feet.
You will most likely have a compression stocking placed on your operated leg after the first dressing change. We like for you to wear this during the day to decrease your amount of swelling. Decreasing the swelling will decrease your pain. It can be removed at night.
Do your bedside exercises as directed by your surgeon or physical therapist.
Physical therapy will start early in your hospital stay.Your surgeon and physical therapist will discuss your goals. When these are satisfactorily met, you will be able to go home from a physical therapy standpoint.
Safety is important in all aspects of your activities. If you have questions concerning any precautions, ask our very knowledgeable orthopedic nursing staff, your physical therapist,or your surgeon.