WHAT TO EXPECT AFTER LEAVING THE OPERATING ROOM

You will wake up in the recovery room.  You can not be visited in the recovery room, but can be visited as soon as you get to your room.  You will be in the recovery room for about 2 hours.  Some patients with medical problems, are admitted to the Intensive Care Unit (ICU) or High Dependency Unit (HDU) for 24 hours before being transferred to the orthopedic ward.  This does not mean that their condition is critical, but only that Dr. Mark Haber or the Anaesthetist feels the need for closer monitoring because of their age or pre-operative medical problems that increase risk.
 

PAIN CONTROL

The PCA Unit (Patient Controlled Analgesia). 

This is a computerized device, which attaches to your intravenous line.  By means of it you are able to self-administer small doses of narcotic by pressing a button at the end of an electric cable. The machine is pre-programmed so that it is not possible for you to give yourself more narcotics than is safe.  It has a number of advantages.  Firstly, you do not need to call a nurse to administer pain injections.  Secondly, because only small doses are given at a time, you will not be as drowsy as you might otherwise be, if you were given big-dose injections every 3 hours.  After 2 days, the PCA unit will be disconnected because it is cumbersome and impedes your progress with physical therapy.  However, if necessary, the machine may be continued for a few more days.  After the PCA Unit is discontinued, pain injections are ordered.  They can be taken every 3 hours if needed.  There are also pain pills ordered for milder pain. A separate booklet on PCA is available

OTHER DRUGS

Drugs are also ordered for nausea, constipation, and sleep.  Note that practically every patient runs a temperature up to 38 degrees or slightly higher  in the first few days after knee replacement. It is so common as to be considered “normal”. It usually settles in the first four days.

Patients may need stool softeners, but many patients still develop constipation and need a mild laxative on the second or third day after surgery. 

All patients are given antibiotics to prevent infection starting just before the operation and for a a day after the surgery.

You must ask for sleeping pills, pain pills or pain injections because the nurses will not automatically give them.  Do not restrict yourself from using the PCA machine or asking for pain medications. We do not want you to be in pain.  You need not fear that you will become addicted to the pain medication.

 In order to prevent blood clots from forming, you are given an injection of a blood thinner.  While you are in the hospital, please let the nurses or the physician know if you have calf pain, chest pain or shortness of breath. These may be signs of blood clots.

Your blood count (Hemoglobin) will be checked after surgery, and you will be given iron supplements and blood transfusions as necessary.
 

DRAINAGE TUBES

Suction drainage tubes are usually placed in the wound to remove any blood that collects after surgery.  In some instances the blood collected in these drains can be returned to you via your drip (re-infusion). (Blood Transfusion for Total Knee Replacement)

This is only possible in specific circumstances. These drains are removed 24 hours after surgery.  Removal is not very painful.

Some patients have difficulty passing urine right after surgery and catheterization is then necessary.

THE OPERATIVE WOUND

The wound will be 10mm in length n the new technique of Minimally-Invasive Surgery (MIS) Quadriceps-Sparing Total Knee Replacement

The dressings are usually changed after the drainage tubes are removed, and as often as necessary after that. Once dry the wound can remain open and you may shower and get it wet. Pat it dry gently so as to not disturb the staples.

PHYSIOTHERAPY
The physiotherapist will get you up on the first or second day after surgery, and will help you mobilize initially with a frame. During waking hours you should “pedal” your feet up and down every five minutes or so, the entire time you are in the hospital, to help prevent blood clots from forming.

Special pneumatic pumps may be applied to your legs during and after surgery.  They massage your calves.  Most patients find them very comfortable.  You may also wear special stockings.  The pedaling exercise, the pumps and the stockings all help to prevent blood clots from forming in your legs. 

By the time you leave the hospital (Figtree or Lawrence Hargrave Hospital) we like you to have at least 90 degrees of knee motion and good control of muscles about your knee.

Most patients by the second or third day after surgery no longer have an IV, and are feeling quite well.  You will be allowed to go home when your temperature is normal and you are able to get in and out of bed by yourself, and go to the bathroom by yourself.  Some patients reach this goal within 8 days; others take ten days or longer. Rehabilitation is frequently recommended after your surgery (usually 5-7 days). This may be at Lawrence Hargrave Hospital. Lawrence Hargrave Hospital has a  indoor hydrotherapy  pool and a trained and qualified pool therapist and a pool rehabilitation program will be organised. You will be admitted under a rehabilitation physician and you will also have a resident doctor allocated to you during your stay. Dr. Mark Haber will usually only visit you there if a problem develops.

EQUIPMENT YOU WILL NEED AT HOME
While you are in the hospital, the physical therapist will help you decide what equipment you will need when you get home.  You will need crutches or a walker to help with walking for about six weeks after surgery.  Crutches are actually easier to handle, but most people feel more secure with a walker. A “reacher” to help you dress or pick things up off the floor may be helpful.  A toilet seat extension may be needed so that you do not sit too low on the toilet.  If you live in a two-story house, it is recommended that you move a bed downstairs and convalesce there, rather than risk using stairs.  You will also need a shower stool.

WHAT TO EXPECT AFTER YOU GET HOME
You will be able to go home in a regular sized car.  It is better if someone can be at home with you for at least portions of each day to assist you with shopping, meal preparation, etc.

Most patients who have had a knee replacement need instruction and visits with a physical therapist for several weeks after they go home.  Usually this is done 3 times a week for 6 weeks.  It is very important that exercises be done vigorously for the first weeks after surgery so that the knee flexibility can be maximized.

Please do the exercises demonstrated by your physiotherapist.  Continue all these exercises for two months.

You must call the office after you get home to set a date for the office visit if this was not done prior to your discharge.  The first office visit after you leave the hospital is usually 6 weeks following the day of surgery.  Until then continue all the restrictions which you were taught in the hospital.  If any problem develops you will need to come in sooner.

It is not uncommon to develop some swelling of the knee, foot and ankle in the weeks after surgery.  If this occurs, you should elevate your leg on pillows when you are not up and about.

Wound sutures or staples are usually removed on the day after surgery.  If you are discharged before that time, they may be removed by a visiting nurse at your home, or you may be asked to come to the office for removal.  It is best to shower rather than get into a tub.  A shower stool is helpful so as to avoid slipping while taking a shower.

Once you get home you are not expected to stay in bed. You should be up and about on your walker or crutches most of the time, but rest as much as you need to. You should also do the exercises

DRIVING AFTER KNEE REPLACEMENT SURGERY.

It is best to avoid driving until about 6 weeks after the surgery but not essential if the left knee has been operated on and you drive an automatic.  Driving is not likely to injure the knee replacement, but you may not be able to operate the car as well as needed to prevent an accident.  Dr. Mark Haber can not judge whether you are safe to drive from a legal standpoint but can simply tell you if you are safe to drive from a standpoint on injuring your knee replacement.

RETURNING TO WORK AFTER KNEE REPLACEMENT SURGERY

You will probably not return to work for 6 to 8 weeks after the operation.  Quite a few patients do return earlier, depending on the nature of their work, and depending on how important it is for them to be back at work.  Discuss this with Dr. Mark Haber if you need to be back at work sooner. The first office visit after you leave the hospital is usually 6 weeks after surgery.

PROBLEMS YOU MAY ENCOUNTER AT HOME

1. Excessive swelling of your leg and foot: It is not uncommon to develop some swelling in the first few weeks after surgery.  If this occurs, you should elevate your leg whenever you are not up to walking.  However, excessive swelling of the foot and lower leg can be due to thrombosis (blood clots) in the veins in the leg. We should be notified if swelling is associated with pain or tenderness in the calf muscles, or if the swelling just seems over-excessive, and doesn’t respond to elevation.

2. Chest pain, a cough or shortness of breath may be signs of embolism. Please do not ignore these symptoms.  Call us right away.

3. Drainage from the wound, or increasing redness around the wound, could signify impending infection.  Our office should be notified, and in most instances you will need to come in and let Dr. Mark Haber take a look at it.

4. High fever could also be a sign of impending infection.  You need to take your temperature twice a day for a month after surgery.  Take it three times a day if it is elevated over 37.5 degrees.  If you get two readings, at least three hours apart, of over 38 degrees, you need to notify us immediately.

5. Increasing knee pain.  Pain should be decreasing from day to day.  If it seems to be steadily increasing, let us know.

6. The knee loses motion.  If Dr. Mark Haber feels that your knee flexibility is not satisfactory (because of developing scar tissue,) he may recommend manipulation of the knee under general anesthetic.  This procedure may be performed before you leave the hospital, or, after you leave the hospital it may be performed as an outpatient.  It involves putting you to sleep for at least 5 minutes during which time Dr. Mark Haber will gently manipulate the knee while you are asleep to break down the developing scar tissue.  It is possible for the femur to fracture during this procedure if you have osteoporosis, but the chances of this happening are extremely small.

IN GENERAL, THE LEG SHOULD BE GETTING BETTER EACH DAY. IF YOU THINK YOU ARE GETTING WORSE IN ANY WAY, PLEASE GIVE US A CALL.

LONG TERM CARE OF YOUR KNEE REPLACEMENT

The main long-term problems of joint replacements is loosening and wear. Annual visits to have your knee examined and x-rayed are essential for monitoring the results of your surgery, and giving you periodic advice for the care of your knee replacement.

With time and stress, fixation of cement to bone can fail. 

It is hoped that in time cementless replacements will prove more able to withstand vigorous activities than the cemented replacements.  They have not been in use long enough for anyone to be sure yet that this will be the case.  Both cemented and cementless knees should therefore be treated with the same care.  You should minimize activities which could cause loosening or excessive wear.  If the implant comes loose, movement between it and bone can cause pain and require re-operation.

IFrom time to time, especially in the first year, you may have  pain. This you can ignore.  If you have pain that doesn’t go away, or seems to increase from day to day, you should come in to see Dr. Mark Haber for x-rays and evaluation.  It could signify infection or loosening.

The longevity of your knee replacement can be increased by avoiding stressful activities such as all types of impact sports including: running, jogging, tennis, badminton, football, baseball, horseback riding, and other activities.  Heavy lifting, weight lifting, jumping from heights, falls and some exercise machines for the legs are dangerous for you. Never lift or carry more than forty pounds.

It is important that you not become overweight, since excess weight increases the stresses on the knee replacement, and can cause loosening. 

The possibility of infection occurring around the replacement is another concern.

For the rest of your life if you develop an infection elsewhere in your body (for example bladder infection, infected cuts, boils, and dental abscesses) this infection can travel via your bloodstream to the replacement.

Therefore, if you develop an infection you should consult your family physician and have him treat it promptly.  Viral infections, such as colds and most sore throats, are not a problem.  Dental work can push bacteria into your bloodstream and cause an infection in your joint replacement.  We recommend that you take antibiotics if you are to have dental work (other than simple cleaning of your teeth).  You will be given a plastic card to keep in your wallet containing information about dosage.

ALWAYS NOTIFY YOUR DENTIST OR ANY TREATING PHYSICIANS  THAT YOU HAVE A JOINT REPLACEMENT.

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