Pre-op and Post-op Knee Guidelines

Planning for your knee surgery prepares you for the operation and helps to ensure a smooth surgery and easier recovery. Here are certain pre-operative and post-operative guidelines which will help you prepare for knee surgery.

Pre-operative guidelines

Please call the hospital to schedule your pre-admission appointment to sign consent forms and discuss financial matters and anesthesia prior to surgery. If indicated you may also require some blood tests and an EKG.
In case medical or cardiac clearance is required for the surgery, it should be submitted at least a week prior to the surgery. This is crucial as surgery cannot be performed until the clearance is received.
Please stop taking all aspirin products, herbal or vitamin supplements and anti-inflammatory medicines at least seven days prior to the surgery. If you are on blood thinning medications, ask your doctor about the discontinuation of this medication prior to the surgery. This is crucial as these medications increase the risk of bleeding and complications of anesthesia. If required Tylenol (Acetaminophen) may be taken prior to surgery for pain relief or headache.
Please inform your doctor about all the medications you are currently taking and clarify as to what can and cannot be taken prior to the surgery.
Please inform your doctor of any change in your medication between your pre-operative visit and the day of the surgery.
Also, inform your doctor if you develop any illness prior to surgery even if it’s a minor problem such as a skin problem or a cold. An infection in the body increases the risk of operative site infection. The lungs should be clear before giving any local, regional or general anesthesia. If the doctor feels that the change in health will affect the outcome of the surgery, the surgery may be postponed to a later date.
If you are unable to undergo the surgery, for any reason, kindly inform the doctor as soon as possible.
Unless instructed otherwise, “Do Not Eat Anything after Midnight Prior to Your Surgery”. You may be allowed to take certain medicines, with a small sip of water, on the day of the surgery.
Shower with an antibacterial soap prior to the surgery to help prevent infection. However, this can be skipped if you are advised to wear a cast or splint.
Please make arrangements for someone to drive you home after the surgery as you will not be able to drive yourself home.

Post-operative guidelines

Knee replacement is a surgery performed to replace parts of a diseased knee joint with an artificial prosthesis. The goal of knee replacement is to eliminate pain and return you to your normal activities. You can help in recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.

After knee replacement surgery, once the anesthesia wears off, you will start to experience pain, for which your doctor will prescribe medication. You may have to remain in the hospital for a few days depending on your progress and overall health. Remember to get plenty of rest during this initial phase. Your surgical wounds should be monitored for swelling, inflammation and other changes and frequent dressing changes are performed. A continuous passive motion (CPM) machine is applied to keep your knee moving, compression boots or elevation of your leg may be recommended to encourage circulation and prevent stiffness, clots and scar formation.

Rehabilitation begins within 24 hours of surgery, where a physical therapist will help you stand up and walk using crutches or a walker. Adhering to the goals of the rehabilitation program is important to help you recover and resume your normal activities. You will be guided to perform strengthening exercises on a daily basis and learn to get in and out of bed, and use a bedside commode. When you are discharged from the hospital, you will be encouraged to walk short distances with an assistive device, climb a few stairs, dress, bathe and perform other basic functions by yourself.

On reaching home, have a family member or caregiver assist you with your activities for a few weeks. Taking care of someone following knee replacement surgery requires compassion, awareness, and patience. Basic points to follow by your caregiver:

Helping with basic movement and functions as well as emotional support
Having a clear understanding of your medication and ensuring they are administered in a timely manner
Keeping emergency numbers ready
Assisting you with household chores, paperwork and traveling to keep your appointments
Helping and motivating you to perform your rehabilitation exercises
Ensuring that furniture is rearranged so as not to interfere with your movement and cause falls.
To avoid bending or reaching out, items that you use frequently can be placed easily within reach.

Certain instructions that your doctor will brief you about are:

You may shower once the wound heals, but avoid soaking in a bathtub for at least six weeks.
Keep the wound clean and dry. Your doctor will let you know when you can shower or bathe.
Some amount of swelling is normal after knee replacement and may last for more than a month. It can be controlled by icing and elevating your leg for 30 to 60 minutes every day.

By week 3, you should be able to move with minimal assistance and a significant reduction in pain. Your physical therapy program will gradually include new and more difficult exercises as you improve in strength and flexibility. By week 7, you should be able to walk independently. To reduce stress, use the opposite knee to lead when climbing stairs and the replaced knee to lead when descending. You will be able to drive a few weeks after surgery when you have sufficient pain control, improved strength and can easily enter and exit a car. Walking and exercising at least 2-3 times a day for 10-15 minutes is recommended for a faster recovery.

You and your caregiver must be aware of the signs of infection. Contact your doctor if you notice any abnormal wound changes or any changes in general health and mental state, or should you have persistent fever, drainage, excessive swelling or other signs of infection.