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Pre-Op Instructions

Total Knee Replacement :: Total Hip Replacement

What you should know before Total Knee Replacement

Things you should know before Total Knee Replacement

Knee replacement surgery is one of the most successful surgeries available today. Studies have shown that patients get more improvement in their quality of life from hip and knee replacement surgery than any other operation from any surgical specialty.

The vast majority of patients who undergo a knee replacement surgery can expect multiple decades of pain relief and increased function from their knee replacement. With modern designs and materials most patients will never need to face a second replacement.

There are some things that you can do to help your knee replacement to last as long as you.

  • You should exercise and eat well to control your weight
  • You should avoid high impact activities such as jogging and sports which require extensive running and jumping
  • After your replacement you should take antibiotics when you have any dental work, a colonoscopy or an endoscopy

Getting ready to have a knee replacement is a process. There are a number of things you will need to think about between now and the time of your knee replacement

  • I feel that it is very important to build up your nutritional status before surgery. Studies have shown that patients with higher levels of protein in their system have fewer infections, fewer complications and heal better. We start at least one month before surgery with a program to increase your nutrition. I recommend that you use a nutrition bar or drink with each meal.
  • Most patients undergoing a knee replacement will not require a blood transfusion. The surgery is performed using a tourniquet and blood is collected in a drain after surgery, filtered and returned to the circulation. Because of this only 1 out of 10 patients will need a blood transfusion after their knee replacement. I require that one unit of blood is available before surgery. You can donate your own blood if you start with enough time ahead of time.  Someone in your immediate family can donate blood for you. Red Cross or banked blood is also an option. There is a very slight risk of disease transmission with banked blood. Current data shows that the risk of hepatitis or AIDS from banked blood is approximately 1 out of 500,000. Most patients will not donate before total knee replacement.
  • Before surgery you will need a complete checkup from your internist or family practitioner. That physician will need to certify that your medical condition is strong enough to withstand major surgery.
  • As part of the pre-surgical evaluation you will have laboratory work and will likely need a chest x-ray and an EKG. Occasionally testing will indicate a potential problem that may delay surgery while it is evaluated.
  • If you have had heart surgery or have had a heart condition you will need approval from your cardiologist prior to surgery.

You will be admitted to the hospital on the same day as your surgery. You will be asked to come to the hospital several hours before your scheduled operation. During that time before your surgery you will be checked in, have an IV started, and meet the anesthesiologist. Most patients undergoing a total knee replacement at Missouri Baptist Medical Center or St. Luke’s Hospital will have a continuous femoral nerve block placed before surgery. This is a small catheter placed along the main nerve in the front of the leg.  Local anesthetics are administered through this small catheter for two days after surgery dramatically decreasing the level of pain. The choice of a main anesthetic will be either a spinal anesthesia or a general anesthesia. A spinal anesthesia is my preference as I feel it gives better postoperative pain relief and a faster recovery. You will need to discuss this choice with the anesthesiologist.

I will keep your family informed of your progress during surgery and will meet with them immediately after surgery. Following surgery you will spend at least two hours in the recovery room and will then be transferred to the orthopedic floor. You can expect to have a splint on your leg after surgery as well as pneumatic compression stockings and support stockings to help prevent blood clots. You will also have a cooling pad over the area of your knee for extra pain relief.

Soon after your surgery you will be started on a continuous passive motion machine (CPM). This device will bend and straighten your leg automatically. It is very important to follow the physical therapy and nursing staff instructions concerning the continuous passive motion machine.

The following day you will start on physical therapy.  Your therapist will work with you first on getting in and out of bed and then walking. Before you leave the hospital your therapist will work with you on going up and down steps and getting in and out of a car.

Most patients can expect to be discharged from the hospital and go home two to three days after their operation. Those patients who are weaker before surgery may need a short stay in rehabilitation afterwards. Because of Federal Government rules rehabilitation in the hospital is no longer an option for most patients and those patients who need extra care will need to go to an extended care facility/nursing home if required. If you feel that you will need extra rehabilitation after your total hip replacement it is best to look into this before your hospitalization.

Before you leave the hospital arrangements will have been made for home health physical therapy and nursing.  A walker and a bedside commode will be arranged.  Your home therapist will meet with you three times a week and you will do home exercises daily. Unless I have told you otherwise you can put your full weight on your operated leg. I will need to see you back in the office in one month after your surgery. Please call ahead for an appointment.

Most patients after total knee replacement will be able to move from a walker or crutches to a cane in two to three weeks. Once you are safe on a cane and you can resume driving a car. You can expect 90% of your improvement after your knee replacement by two months. However it may take six to nine months for you to get complete improvement.

Risks of Total Knee Replacement

Total knee replacement has an overall excellent result rate of 95%. However some patients may develop complications despite all efforts to prevent them.

  • Surgery requires anesthesia which has an inherent risk. Your anesthesiologist will discuss this with you further
  • Infection is a risk of in all surgeries. The infection rate of a total knee replacement is just under 1%.  A superficial infection could be treated with antibiotics but a deep infection of the knee prosthesis will require that the knee prosthesis be removed and a temporary spacer implanted for two to three months before a new prosthesis can be implanted. You will be given antibiotics before surgery and for 24 hours after surgery to help prevent infection
  • During the performance of your total knee replacement there is a chance that the bone could crack as the prosthesis is implanted. This may require that I add extra wires or screws and that you limit your weight-bearing after surgery for up to six weeks.
  • Potential damage to nerves in that knee or leg can lead to loss of function in the leg or foot including a foot drop. This is a very rare complication
  • There is a potential for damage in other areas of the body during any surgery. During surgery you will be well-padded to help prevent damage in other areas
  • There will be numb spots around your incision
  • Artery or vein damage in the knee or leg can lead to further surgery or even loss of the leg. This is an extremely rare complication
  • Deep venous thrombosis (DVT) or a blood clot in the leg can cause pain and swelling in the lower leg and can lead to a pulmonary embolism (PE) which is a blood clot that travels to the lungs and blocks circulation to the lungs.  This can cause severe illness or even death.  Without prevention the risk of blood clots in the legs following a total knee replacement can be as high as 75%. Because of this high a risk I am very aggressive in treatment to prevent blood clots.  After surgery you will be on a blood thinner shot that you will need to continue after your discharge from the hospital. The nurses will teach you how to give this shot to your self.  You will also have thigh-high support stockings and a pneumatic compression device which will squeeze your legs to keep the blood flowing. The nursing staff and I will also encourage you to paddle your feet and ankles and move your legs to keep the blood flowing. You will also be encouraged to get out of bed and get moving quickly.
  • It is very important to recover range of motion as soon as possible after surgery. Gains in range of motion cannot be made without some discomfort. Full knee extension (straightening) must be obtained in the first six weeks after surgery or it is not likely to be obtained. Pain control is important to regain range of motion.
  • While we expect over 90% of total knee replacements to be successful for decades, there is a failure rate. This can occur due to loosening of the prosthesis, wear of the prosthesis, a fracture around the prosthesis or a late infection of the prosthesis. This may require another knee replacement.

There are other potential risks following knee replacement surgery.  Those risks are rare.

 

What you should know before Total Hip Replacement

Things you should know before Hip Replacement Surgery

Hip replacement surgery is one of the most successful surgeries available today. Studies have shown that patients get more improvement in their quality of life from hip and knee replacement surgery than any other operation from any surgical specialty.

The vast majority of patients who undergo a hip replacement surgery can expect multiple decades of pain relief and increased function from their hip replacement. With modern designs and materials most patients will never need to face a second replacement.

There are some things that you can do to help your hip replacement to last as long as you.

  • You should exercise and eat well to control your weight
  • You should avoid high impact activities such as jogging and sports which require extensive running and jumping
  • You should avoid the extremes of motion that may risk a dislocation
  • For the first two years after your replacement you should take antibiotics when you have any dental work, a colonoscopy or an endoscopy

There are several different types of hip replacements available.  We will talk about which will be best for your hip.

Getting ready to have a hip replacement is a process. There are a number of things you will need to think about between now and the time of your hip replacement.

  • I feel that it is very important to build up your nutritional status before surgery.  Studies have shown that patients with higher levels of protein in their system have fewer infections, fewer complications and heal better. We start at least one month before surgery with a program to increase your nutrition. I recommend that you use a nutrition bar or drink with each meal
  • Most patients undergoing a hip replacement will require a blood transfusion. I recommend that patients have two units of blood available at the time of a hip replacement surgery. You can donate your own blood if you start with enough time before your surgery.   Someone in your immediate family can donate blood for you.  Red Cross or banked blood is also an option. There is a very slight risk of disease transmission with banked blood.  Current data shows that the risk of hepatitis or AIDS from banked blood is approximately 1 out of 500,000
  • Before surgery you will need a complete checkup from your internist or family practitioner. That physician will need to certify that your medical condition is strong enough to withstand major surgery
  • As part of the pre-surgical evaluation you will have laboratory work and will likely need a chest x-ray and an EKG. Occasionally testing will indicate a potential problem that may delay surgery while it is evaluated
  • If you have had heart surgery or have had a heart condition, you will need approval from your cardiologist prior to surgery

You will be admitted to the hospital on the same day as your surgery. You will be asked to come to the hospital several hours before your scheduled operation. During that time before your surgery you will be checked in, have an IV started and you will meet the anesthesiologist.  Most patients undergoing a total hip replacement at Missouri Baptist Medical Center or St. Luke’s Hospital will have a general anesthetic although spinal anesthesia is also a good option. You will need to discuss this choice with the anesthesiologist.

I will keep your family informed of your progress during surgery and will meet with them immediately after surgery.   Following surgery you will spend at least two hours in the recovery room and will then be transferred to the orthopedic floor. You can expect to have a special pillow that protects against dislocation between your legs after surgery as well as pneumatic compression stockings and support stockings to help prevent blood clots.

The following day you will start on physical therapy. Your therapist will work with you first on getting in and out of bed and then walking. Before you leave the hospital your therapist will work with you on going up and down steps and getting in and out of a car.

Most patients can expect to be discharged from the hospital and go home two to three days after their operation. Those patients who are weaker before surgery may need a short stay in rehabilitation afterwards.  Because of Federal Government rules rehabilitation in the hospital is no longer an option for most patients and those patients who need extra care will need to go to an extended care facility/nursing home if required. If you feel that you will need extra rehabilitation after your total hip replacement it is best to look into this before your hospitalization.

Before you leave the hospita,l arrangements will have been made for home health physical therapy and nursing.  A walker and a bedside commode will be arranged. Your home therapist will meet with you three times a week and he will do home exercises daily. Unless I have told you otherwise you can put your full weight on your operated leg. I will need to see you back in the office in one month after your surgery.

Most patients after total hip replacement will be able to move from a walker or crutches to a cane in two to three weeks. Once you are safe on a cane and you can resume driving a car. You can expect 90% of your improvement after your hip replacement by two months. However it may take six to nine months for you to get complete improvement.

Risks of Total Hip Replacement

Total hip replacement has an overall excellent result rate of 95%. However some patient’s may develop complications despite all efforts to prevent them.

  • Surgery requires anesthesia which has an inherent risk. Your anesthesiologist will discuss this with you further
  • Infection is a risk of in all surgeries. The infection rate of a total hip replacement is just under 1%.  A superficial infection could be treated with antibiotics but a deep infection of the hip prosthesis will require that the hip prosthesis be removed and a temporary spacer implanted for two to three months before a new prosthesis can be implanted. You will be given antibiotics before surgery and for 24 hours after surgery to help prevent infection
  • During the performance of your total hip replacement there is a chance that the bone could crack as the prosthesis is implanted. This may require that I add extra wires or screws and that you limit your weight-bearing after surgery for up to 6 weeks
  • Potential damage to nerves in that hip or leg can lead to loss of function in the leg or foot including a foot drop. This is a very rare complication
  • There is a potential for damage in other areas of the body during any surgery. During surgery you will be well-padded to help prevent damage in other areas.
  • There will be numb spots around your incision
  • Artery or vein damage in the hip or leg can lead to further surgery or even loss of the leg. This is an extremely rare complication
  • Deep venous thrombosis or a blood clot in the leg can cause pain and swelling in the lower leg and can lead to a pulmonary embolism which is a blood clot that travels to the lungs and blocks circulation to the lungs. This can cause severe illness or even death.  Without prevention the risk of blood clots in the legs following a total hip replacement can be as high as 75%. Because of this high a risk I am very aggressive in treatment to prevent blood clots. After surgery you will be on a blood thinner shot that you will need to continue after your discharge from the hospital.  The nurses will teach you how to give this shot to your self. You will also have thigh-high support stockings and a pneumatic compression device which will squeeze your legs to keep the blood flowing. The nursing staff and I will also encourage you to paddle your feet and ankles and moved your legs to keep the blood flowing. You will also be encouraged to get out of bed and get moving quickly
  • You can expect that there will be a slight difference in the length of your operated leg and the other leg.  Most people will never notice this slight difference once they have completed their rehabilitation.  Almost all patients will feel that the leg with the new hip is much longer immediately after the surgery. This is caused by a weakness in the pelvic musculature and will resolve with physical therapy. Occasionally it is necessary to moderately lengthen the operated leg to make the hip more stable and less likely to dislocate. It is my opinion that it is better to have a slightly longer leg in that case than an unstable hip
  • Traditional hip replacements have a dislocation rate of 3 to 4%. This usually happens when the patient places the leg in an improper position. Following your hip precautions after surgery can decrease the risk of dislocation. The newer designs of hip replacement that I currently use have a much lower rate of dislocation
  • While we expect over 90% of total hip replacements to be successful for decades there is a failure rate. This can occur due to loosening of the prosthesis, wear of the prosthesis, or a late infection of the prosthesis. This may require another hip replacement

There are other potential risks following hip replacement surgery. Those risks are rare.