Preparing for Your Total Knee Replacement Surgery

Preparing for a total knee replacement begins several weeks ahead of the actual surgery date. Good physical health before your operation is important. Keeping or getting your upper body strong will improve your ability to use a walker or crutches after the operation. Performing leg-strengthening exercises will help with your recovery also.

Medical Management

You will need to attend the following appointments in preparation for your surgery:

  • Orthopaedic pre-operative physical exam
  • Co-management (Internal Medicine)
  • Anesthesia will either call you or set up an appointment
  • We may also ask you to see other doctors for your heart, lungs, mental health and/or blood
  • Dentist

We can’t always get these appointments scheduled on the same day, so you may have to make several trips.

You and your doctor will make a plan about what to do about the blood you lose during surgery. We now try to give you a medication during the operation that helps decrease the need for blood transfusion after surgery. You will be evaluated at your orthopaedic pre-op physical exam to determine whether or not you are an appropriate candidate for this medication. If you are not an appropriate candidate to receive this medication, you are at higher risk of needing a blood transfusion after surgery.

Please schedule an appointment with your dentist if you have not had a dental check during the last six months. An infected tooth or gum could cause your new knee to get infected.

Smoking

If you smoke tobacco, we highly encourage you to quit. Both for your general health and to help your wound heal after surgery.

Dr. Noiseux and Dr. Willenborg patients: You must quit smoking and demonstrate a negative urine test before your surgery is scheduled.

Preparing for Surgery and Recovery

When getting ready for surgery, you should begin thinking about the recovery period after surgery.

  • You will be able to go home from the hospital two to four days after surgery
  • You will need someone to stay with you at home for at least the first three to five days
  • You will need help dressing, getting meals, etc.
  • Your energy level will not be normal at this time

If you do not have anyone to help you when you go home, you may need to go to a nursing facility until you regain strength and can care for yourself. Your social worker can help with these arrangements.

Pre-Operative Visit

All patients come to the clinic before their surgery to meet with the health care team. This visit will take several hours, so you should plan to spend at least half the day or more to complete it.

The visit begins in the Orthopaedic Clinic, where a nurse will ask you about your medical history and the medicines you take, including prescription medicines and over-the-counter medicines. Bring a list of your past surgeries and a list of the medicines with the dose (amount) that you take at home.

Blood and urine samples will also be taken. Urinary tract infections are common and many people don't know they have an infection.

The physician assistant/nurse practitioner will meet with you to review your medical history and the medicines that you take. She/he will check you for infection. Any blisters, cuts, or boils should be reported. If you have an infection, surgery is generally delayed until the infection is gone. Additional x-rays are taken if needed.

Before you leave the hospital make sure your questions are answered. If at any time before your scheduled surgery, you become ill, such as with a cold or flu, you need to call your orthopaedic doctor at University Hospitals right away. Remember we want you to be in your best possible health when you come for surgery.

Diet

You can brush your teeth the day of your surgery, but do not swallow anything. You can drink a total of eight ounces (one cup) of clear liquid from midnight until two hours before your surgery. You may not eat solid food on the day of surgery. Your choice of a clear liquid will include black coffee, clear tea, water, apple juice or soda.

Bathing

You will shower or bathe the night before your surgery. Please use the special soap you get at your pre-operative visit (chlorhexidine or Hibaclens). We will instruct you on how to do your scrub. You will also need to shampoo your hair. Nail polish and make up should be removed. Do not shave your legs within five days of surgery.

How to Clean Your Skin Before Surgery

Why is it important to clean my skin before surgery?
Your skin is not sterile, so it is important to lower the amount of germs on your skin. Bathing with special soap will help protect you from getting an infection after surgery.
What should I use to clean my skin before surgery?
You will use a liquid soap called CHG (chlorhexidine gluconate). This soap is also sometimes called Hibclens. CHG will help lower the number of germs on your skin. It works to lower the number of germs right after you bathe. It also keeps lowering germs for many hours after you shower as well.
You will be given a bottle of CHG, but if you lose or forget it, you can buy CHG or Hibiclens at a drugstore or pharmacy. You do not need a prescription.
What is the right way to bathe with CHG?
If you test negative for Staph, shower with the CHG just the night before surgery.
If you test positive for Staph, you need to shower and wash your hair using CHG each day for 5 days before surgery.
Follow these steps for cleaning with CHG:
  1. Take out all body piercing jewelry before your first CHG. You should not put body piercing jewelry back in until after your surgery.
  2. Use small amount of CHG on your scalp, chest, belly, back, arms and legs. Softly wash your skin with the CHG soap for 5 minutes. Do not stand under the water or rinse off CHG until your 5 minutes are up.
  3. Be sure to clean the skin around where you are going to have surgery.
  4. Rinse your body off with water when your five minutes are up.
  5. Pat yourself dry with a clean, dry towel.
What should I avoid while using CHG to clean myself?
  • Do not put CHG in your eyes, mouth, ears or genitals. Rinse these areas with water if you get CHG in them.
  • Do not scrub your skin hard with CHG. This could cause a rash or irritation.
  • Do not shave the skin around your surgery site before or after using CHG.
  • Do not wash your skin with your normal soap after washing with CHG.
  • Try not to use lotion, powder, deodorant or perfume/aftershave on skin after using CHG. If your skin is very dry you can use water-based lotions such as Lubriderm® Unscented.
Who should I call if I have questions or concerns about using CHG?
Orthopaedic Clinic: 319-356-3844

Blood Clot Prevention

We use special devices help to keep your blood moving through your legs after surgery. You will be taught ankle exercises to help increase blood circulation in your legs too.

Medicine will be given to you to thin your blood after surgery. Your doctor will decide what is best for you. More information on which medication your surgeon will use is listed later.

Anesthesia

You will be asked a series of questions before your Orthopedic work-up to see if you need to see a member of the anesthesiology team. If you do screen in to see them, we will try to coordinate an appointment on the day of your work up. If you do not screen in to see them, a member of the anesthesiology team will call you before your surgery to talk about your choices of anesthesia and review your medical history. He/she will talk to you about what medicines to take on the day of your surgery.

Pain Management

Good pain management is one of the best ways to ensure you are able to comfortably walk and go to physical therapy after surgery. You will be asked to rate your pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst possible pain.

You will be given pain medicine after your surgery and a prescription to take home with you. We will manage your pain after surgery for a maximum of 3 months under normal circumstances.

Deep Breathing Exercises

The nurses will teach you how to do deep breathing exercises and how to use a device called an "incentive spirometer." These exercises are needed to help remove fluids that may settle in your lungs while you are asleep during surgery and helps prevent pneumonia.

Activity

Some patients have discomfort in their back after surgery. This is caused by the general soreness of the knee area and partly by the lack of movement required before, during and after surgery.

It is very important to gradually increase your walking every day.

Therapy and Rehabilitation Program

After surgery you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed and doing exercises to improve the range of motion and strength of your knee.

Your physical therapist will give you an exercise program for home. In addition to exercises for you to do in your home, you may have to go in to a clinic for more therapy after your discharge. Your doctors and therapists will let you know if this is needed.

Dr. Callaghan — Physical therapy at least 3 times per week for 6 weeks as well as home exercises in between
Dr. Clark — Physical therapy at least 3 times per week for 6 weeks as well as home exercises in between
Dr. Noiseux — No physical therapy under normal circumstances; encourages walking every hour and doing home exercises
Dr. Willenborg — Physical therapy at least 3 times per week for 6 weeks as well as home exercises in between
Dr. Marsh — Physical therapy at least 3 times per week for 6 weeks as well as home exercises in between
Dr. Miller — Physical therapy at least 3 times per week for 6 week as well as home exercises in between