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Knee Replacement Surgery – What You Need To Know From Someone Who Has Been There

BEFORE

Knee Replacement is scary enough, but you can do it because I, the biggest baby in the world, did it! Once you and your Doctor have decided that you need your knee replaced, it’s time to make preparations.

First and foremost, check with your insurance company to make sure what benefits you have. Find out specifically how long they will allow you to stay in the hospital. Many insurance companies will make you leave the fourth day after the operation and they may send you to “rehabilitation”, which in their jargon could mean a nursing home.

In my experience, I was transferred to the nursing home on Friday. This meant that I would not be evaluated by their visiting physical therapist until Monday. Because of this I went from a 90 degree bend in my new knee to a 70 degree bend, in just three days. All my rehab in the hospital just went down the drain and I had to start over. Just so you know, you will be working towards a 125 degree bend after the Knee Replacement Surgery.

I won’t even go into the other sides of being in a nursing home. One funny thing that did happen is that I was the hot new chick; remember this is a nursing home. So, it is very important to know how the insurance company will treat you before, during and after the knee surgery.

Call the number on the back of your insurance card and ask the following questions:

o Find out who you are talking to, their position and their extension.

o I want to know what benefits I have for total Knee Replacement.

o Do I have skilled Physical Therapy benefits at the hospital where the Knee Replacement surgery takes place? Yes or no? If so, what are they?

o Do I have Rehabilitation benefits for the Knee Replacement? Yes or no? If so, what are they? Where can I go for the services?

o Do I have Rehabilitation equipment and supplies covered for the Knee Replacement? Yes or no? If so, what are they? Is there a co-pay?

o Do I have continued outpatient therapy benefits for after the Knee Replacement? Yes or no? If so, what are they? Where can I go for services?

o Do I have home therapy benefits after Knee Replacement? Yes or no? If so, what are they? What Home Health Agencies Can I Use After Knee Replacement?

To maintain your independence at home, after your Knee Replacement Surgery, purchase a bar fridge that will go on a table next to your bed. This will be invaluable when you get home. Try it with water, sodas, milk, Jell-O’s and individual pudding snacks. Fresh fruit is also a good snack. Buy the 2 oz boxes of cereal and stack them next to the fridge. Place a large plastic drinking cup next to the bed and weigh it down with a golf ball that will hold plastic utensils, knives, forks and spoons (the golf ball keeps it from tipping over). Use a plastic bowl for the cereal and throw it away when you’re done. Bumblebee Tuna makes an individual lunch kit that comes pre-made with crackers and a small wooden spoon.

These little things will help you feel independent, being able to take breakfast, snacks and the occasional lunch on your own. It also gives your caregiver a break. I found there were some days I had no appetite due to pain and/or medication, so I kept a stock of Slim Fast or Boost in the fridge for basic nutrition.

If you smoke, now is the time to quit or at least cut down. Smoking constricts your blood vessels, which is not good when you are going for major surgery. If you tend to be a little overweight, try to lose a few kilos. A little less weight on a new knee joint, means a little less pain. Okay, no more preaching.

Line up the people who will help you after your Knee Replacement Surgery and, believe me, you will need them. If you can afford it, hire someone to come in for 4-6 hours a day. They will help you get out of bed, shower and get dressed. They prepare your meals, help you with your therapeutic exercises, keep you company, and give your spouse or significant other a break. Interview them now and let them know what your time is like. Your church would be a good place to find someone, or if you live near a retirement community, many times they have companions of their own who are looking for some extra income.

This is not essential but I think it is wise. Donate two pints of your own blood in case of emergency. Make sure this is completed at least a week before surgery. You must donate one pint per week. If you are taking antibiotics, wait five days before donating blood. The blood bank will give you a card with the unit number on it, which you present after admission to the hospital.

You will need to put Shrimps in your shower/tub (don’t use your towel strips). Put them in before you have the surgery, installation is not that difficult and you will appreciate the help for the next couple of months. This is a serious security issue. Balance will be difficult after your Knee Replacement Surgery especially the first two weeks. You should buy a shower stool so you can sit while bathing. Your doctor may provide you with a cast protector to keep your new knee dry.

Buy three rubber mats, one for in the shower/tub and the other two to be lined up parallel outside the shower/tub. You don’t want to slip on a wet bathroom floor.

There is a product; disposable body washcloth, available, which you can use to bathe in your bed. They can be put in the microwave to be heated and you can use them on days when you just can’t face the shower. They come in packs of eight. While they say to use all eight for one bath, I found four to be enough. Just close the remaining four and use save them for next time.

You will need a pair of slippers that cover the whole foot with a non-slip bottom, slippers are too dangerous. You’ll also need a pair of lace-up shoes for stability.

Some other items you may need are:

o Television with Remote Control

o Telephone/emergency numbers

o Night light for the bathroom

o Hand towels

o Bed Commode/Necessary paper

or tissues

o Dental floss, toothbrush, toothpaste

o Ring a bell for help

Another suggestion is to eliminate all roads in your home. Loose rugs and cords are often the cause of falls, as are pillows and magazines. Remove articles from around the bed and chairs. Keep your pets under control. A napping cat or playful puppy in the wrong area can cause accidents.

Get a manicure, pedicure and haircut. They will be the last for at least eight weeks. Hell, if you can afford it, throw in a massage. If you like baths, take a long hot soak with lots of bubbles. This will be the last time you use your tub for that activity for a while.

Draft a Directive and Declaration of Living Will. Sign a Durable Power of Attorney/Power of Attorney, and appoint a Health Surrogate. These are for your protection and are very important.

Do not take anything of value. Leave your purse, your wallet, money and jewelry at home. If you’re female, bring some makeup. It will make you feel better and take your mind off your knee for a while. Bring a book, you might not read it, but at least you’ll have something to take your mind off why you’re there.

DURING AND AFTER YOUR BIG DAY

Here’s how your day of surgery will progress:

 Come to the hospital promptly at the time specified by the reception desk. Paperwork must be done before you are accepted.

 After being admitted, you will go to the pre-op room where the nurses will review your test results and history. They will prepare you for surgery. Whoever brought you to the hospital will be able to stay with you until this point.

 The nurses will insert an IV before surgery and infuse your prescribed antibiotic.

 You will be taken on a boardwalk to the operating room “holding area”.

 This is where you will see the anesthesiologist before surgery. He will ask you how much you weigh. Don’t even think about lying. The amount of anesthesia is based on your weight.

 After the surgery you will wake up from the anesthesia feeling anxious. Your mouth will be dry and there will be pain at the surgical site. You will be given pain medication and ice chips.

 A thick bandage and drain will be in place.

 You may have compression stockings on both legs to prevent the risk of blood clots.

 Once your blood pressure, pulse and breathing are stable, you will go to a room in the Orthopedic/Surgical Unit.

The balance of the day is recovering from the surgery. You will be very tired so sleep as much as possible. It will be annoying but the nurses will come in very often to check your vital signs and, yes, they will wake you up. Use this day to sleep, relax and keep yourself calm. Physical therapy starts tomorrow.

o You may be able to drink water after surgery when you are fully awake. Your diet will be soft and progress as you can tolerate it.

o Your doctor may have ordered PCA (Patient Controlled Analgesia) to control your pain medication, or injections and/or pain pills. If the PCA is ordered, the nursing staff will provide additional information on how to use its button.

o Nurses will periodically ask you to rate your pain intensity on a 0-10 scale. (0=No Pain, 10-worst pain ever). To be honest!

o You will be asked to take a deep breath and cough. You should do this every 1-2 hours while you are awake to prevent congestion in your lungs. The doctor may even order an incentive spirometer to inhale. Exhale deeply and hold for 3 seconds and then inhale. Do this 10 times every hour while you are awake.

o Flex your ankles 10 times every hour while you’re awake to reduce the risk of blood clots in your legs.

o Turn from your back to your sides every two hours to prevent skin irritations and help circulation.

If you want more information about the specific graphic detail of the operation, go to http://www.JointReplacement.com. You can get every last detail there.

Okay, it’s the day after surgery and the physical therapy department knows you’re here, they know your room number and they know the bed number. They will come, ha ha. The therapists know how to treat you, let them guide you. It will be painful. Try to find out from the nurses what time your treatment is scheduled so that you can time the pain reliever thirty to forty minutes before they arrive.

Things that should be ordered by your Doctor from a medical store, delivered to your home and covered by insurance:

o Above the toilet commode with arms

o Commode for next to the bed for use at night

o Wheelchair

o Crutches

o Cast/injury protector for the shower

One thing that is very helpful is “Reacher Arm”. It’s invaluable for picking up things you drop or can’t reach.

You must do all the exercises that the doctor orders. The more you do them, the faster you will recover. I won’t lie to you, the exercises will hurt but they really are essential. If you have access to a pool, use it to do water exercises that will build your muscles and ligaments, so it won’t give as much.

One last thing, get as much sleep as you can. While you sleep your body heals!

Good luck with your replacement and I promise you it will be worth it!

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