ARTHRITIS OF THE KNEE JOINT

You will wake up in the recovery room. You will be comfortable and usually surprisingly free of pain. 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 are admitted to the Intensive Care Unit (ICU) for 24 hours before being transferred to the orthopedic floor. This does not mean that their condition is critical, but only that Dr. Huddleston feels the need for closer monitoring because of their age or pre-operative medical problems that increase risk.

A major breakthrough in pain-management has been the development of a device known as 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 narcotic 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. Suitable patients are given ketorolac (Toradol) in addition to the PCA for added pain control.

OTHER DRUGS

Drugs are also ordered for nausea, constipation, and sleep. If you run a fever you will be given extra-strength Tylenol.

All patients get 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 (see Complications of Knee Replacement Surgery) starting just before the operation and for a few days after the surgery.

In order to prevent blood clots from forming (see Complications of Knee Replacement Surgery), most patients are given Coumadin (warfarin), which is a blood thinner. The internist calculates the dosage of Coumadin by daily blood tests. If the blood becomes too “thin” then bleeding problems can develop. If you do form blood clots you will be given heparin intravenously and be confined to bed for about three days, and then physical therapy will be resumed.

If you are put on Coumadin the internist may want you to continue it for a few weeks after you leave the hospital. He will give you a “take home” prescription for the Coumadin, and order any necessary blood tests needed.

Your blood count (Hemoglobin) will be monitored on a daily basis for a few days, 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 which collects after surgery. Some of this blood will be filtered and given back to you intravenously. This technique is called "re-infusion". The drains are removed 2 days after surgery. Removal is not painful.

Many patients have difficulty passing urine right after surgery and catheterization is then necessary. For this reason, we may insert a urinary catheter (in most patients during anesthesia), and remove it on the second post-operative day. Removal is also not painful. We try to avoid catheters for longer than necessary because urinary infection can develop.

THE OPERATIVE WOUND

The wound is over the front of the knee and will be about six inches in length. The dressings are usually changed after the drainage tubes are removed, and as often as necessary after that.

PHYSICAL THERAPY

The physical therapist will get you up on the first or second day after surgery, and will teach you the right amount of weight to put on your operated leg.

Special pneumatic pumps will be applied to your legs in the recovery room, and will be kept in place for several days. They massage your calves every forty-five seconds. 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.

After the surgery (usually on the second day) the leg is placed in a CPM (Continuous Passive Motion) machine which will gradually exercise your knee. This machine is not particularly uncomfortable and will help you regain your knee movement. The amount of movement that the machine goes through will be gradually increased over the course of your hospitialization. You will be taught how to increase the amount of bending by adjusting the controls on the CPM. Please try to increase the amount of bending as much as possible, even if it hurts to do so. Ask for pain medication if necessary to help you work on this. The therapist will come twice a day and exercise your knee out of the machine. You should plan to use the CPM machine for at least 8 hours out of each day. By the time you leave the 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.

EQUIPMENT YOU WILL NEED AT HOME

While you are in the hospital, a social worker and 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 hospital bed is hardly ever needed at home, but we will be happy to order one for you if you want it. Most insurance plans cover it. We will provide a “reacher” to help you dress or pick things up off the floor. A toilet seat extension will 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 thermometer and a shower stool.

THE REHAB OR SKILLED NURSING UNIT

You may be transferred to the rehab unit for a few days of additional therapy. Patients who live alone and have no one to help at home, are advised to stay in the hospital’s Skilled Nursing Unit (SNU) for additional therapy and general care. You can stay there for up to 3 weeks if necessary. Medicare will cover your stay there. Your internist will see you regularly in the SNU. Dr. Huddleston will visit you there once a week unless a problem develops which needs his attention.