by Dr. David A. Fisher, MD | August 9, 2018

Knee Replacement Surgery: Tips and What to Expect

 Highlights

  • Successful surgery and recovery starts with preparing before surgery
  • Surgery may range from 45 to 90 minutes
  • The sooner physical therapy starts, the quicker patients regain their knee function and independence
  • Pain management is fundamental to recovery success

Preparing for surgery

If you are preparing for total knee replacement surgery, there are several things you can do to help prepare and make your recovery easier.

  1. If you have other medical conditions, it is helpful to get those conditions optimally treated before your surgery. This includes high blood pressure, diabetes, heart conditions, obesity, and other medical conditions. In addition, if you need dental work, it should be done before your surgery.
  2. If you are able, preoperative exercises to strengthen your upper and lower extremities is helpful to regain your mobility after surgery. The stronger your leg muscles are before surgery, the quicker you will regain independence in your knee function. These exercises include straight leg raising, riding an exercise bike, or the use of weights on your ankle if you are able. You will need to use your arms to help in transfers and walking for the first week.
  3. You can eat a regular diet up to the night before surgery. Depending on the time of your surgery the next day, you may be asked to not eat or drink anything after midnight before your surgery. You should get instructions from the hospital before regarding your diet.
  4. Most people will return home within 24-48 hours of surgery. At that time they are able to transfer in and out of a chair or bed, walk with a walker or crutches, and go up and down stairs in a safe manner. It is often helpful to organize your home before surgery so it is easier when you return. Having ready made meals makes it easier in the kitchen. If you sleep upstairs and think you may want to stay on the main floor a few nights, organizing things to have a day bed or sleeping option on the first floor can be helpful. Having someone around to help with household chores is helpful for the first week or two. You also are not likely to be able to drive for several weeks after surgery, so having supplies and food in the house prior will make it easier.

Day of Surgery

As for the day of surgery, once you check into the hospital, there will be many things happening in the background. The medical staff will be checking you in and preparing you for surgery. There will be consent forms to sign and other last minute items to address. You may be asked to wash with a special antibacterial solution to reduce your risk of infection. This preoperative preparation can take up to 2 hours and the hospital staff will tell you when you should be there.

Once the operating room is ready, you will be transferred to that room where the surgical process begins with induction of an anesthetic. This could be from spinal or nerve blocks, or general anesthesia. The surgery time for a total knee varies depending on the patient and the surgical team, but may range from 45 to 90 minutes. Once completed, you will be transferred to the recovery room and stay there for another 45-60 minutes. Once you are awake and ready to go your assigned hospital room, you will be transferred there, where you can see your family, get something to eat, and start your rehabilitation. Most patients will get their first session of physical therapy within a few hours of returning to their room. It is also helpful for patients to start their leg raising and flexion exercises as soon as they are awake enough to do them. The sooner this process starts, the quicker patients regain their knee function and independence. In hospital therapy usually continues twice a day, and can be continued after discharge with either in-home therapy or outpatient therapy if your physician recommends it. Discharge to home is usually within 24-48 hours.

After Surgery

Pain management is an important part of the surgical process. There are many means to help control postoperative pain and most surgeons will use multimodal pain options to help patients. However, some patients have difficulty with some pain medications due to adverse reactions, or allergies. If you have problems with pain medications, let the medical staff know before your surgery. Cold therapy, leg elevation, listening to music, and moving the leg are some easy ways to help control postoperative pain. Medications can be added to help during your recovery. The early postoperative pain will improve daily for the first several weeks, and most people are able to discontinue narcotic pain medicines within 2-6 weeks.

Sleeping through the night is usually difficult for the first 6 weeks as the knee tends to ache at times, reminding you that you just had surgery. This is part of the healing process and gradually improves in the first 2 months. While the knee continues to improve for 6-12 months, most patients are able to return to most activities by 2 months after surgery.

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