WHAT TO EXPECT WITH
A KNEE REPLACEMENT

You will need to arrive about two (2) hours before your scheduled surgery time. The pre-surgery registration takes place on the seventh floor at Haywood Regional Medical Center. From there, the staff will escort you to the preoperative area on the first floor.

A spinal block will be performed by the anesthesiologist. Don’t worry, you will still be “napping” during surgery. The spinal block decreases the amount of anesthesia needed, leading to less pain and quicker recovery after surgery.

If you are going home on the day of surgery, you will return to the seventh floor. Our wonderful physical therapists will work with you on safe ambulation after the spinal block wears off. Once you have walked successfully, you will get to go home!

If you are staying overnight, you will have a private room on the fifth floor. The physical therapists will work with you either on the day of surgery or the next morning. Plan to discharge around noon.

Make sure to bring your walker with you to the hospital.

Try to remain as active as you can leading up to the surgery. There are no specific exercises needed.

Make sure that you fill your prescriptions ahead of time. More on this below.

You will need to do a couple of things before surgery to help reduce your risk of infection.

1. Mupirocin - apply a pea-sized amount to the inside of your nose for the five (5) nights leading up to surgery. This helps decolonize bacteria on your skin surface

2. Chlorhexidine soap - this will be given to you at your preoperative visit.

Physical therapy is essential for a successful outcome. It is equally important as the technical execution of the surgery.

There are two options for therapy: outpatient vs in-home. Outpatient PT involves visits to the physical therapy center, whereas in-home PT is performed in your home. In general, outpatient PT is advisable unless you have restrictions or limited mobility that make it difficult to come to outpatient PT sessions. We aim to begin PT within a few days of the surgery.

You should also work on rehab exercises several times daily on your own. The most important exercises are:

1. Straight leg raises

2. Flexion - trying to bend your knee back as far as you tolerate with mild discomfort

3. Working on full extension - it is imperative that your knee is able to fully straighten after surgery. Any time that you are relaxing or lying down, prop your heel up on a pillow and allow the back of the knee to hang freely. This will help stretch the hamstrings and allow the knee to fully straighten

4. Walking - in general, the more walking, the better (within reason)

Here is the recommended rehab protocol from the American Association of Hip and Knee Surgeons:

Home Therapy Exercises After Total Knee Replacement

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Fortunately, knee replacement is a very common, safe, and successful surgery. It is important to have a fellowship-trained surgeon who regularly performs these surgeries in order to minimize the risk of complications. Below is a list of possible complications following surgery. The chance of any of these happening is less than one percent.

1. Periprosthetic fracture - this is where the bone breaks around the implant

2. Instability - over time, it is possible for the ligaments around the knee to become more lax, leading to feelings of instability

3. Infection - infection of a prosthetic joint is a terrible problem. I use many techniques to reduce the chance of infection. These include careful soft-tissue handling, draping technique, preoperative skin decolonization, betadine lavage, and perioperative antibiotics

4. Implant loosening or wearing out over time - this is much less common with modern implants and cement techniques

5. Persistent pain and stiffness - A certain proportion of patients do not regain full motion, especially if the knee is stiff preoperatively

6. Numbness around the incision

7. Medical complications (e.g. heart attack, stroke, blood clots)

I utilize a few different types of pain medication to achieve adequate pain control and minimize the amount of narcotics needed.

1. Oxycodone - take this only as needed. You will almost certainly need this for the first couple of days after surgery. It is important to stay ahead of the pain during this time period, and it is acceptable to take two (2) tablets during this time if needed. After this, you should taper off as quickly as your pain allows.

2. Celebrex - this is a strong anti-inflammatory medication. You will take it twice daily for two (2) weeks. Take this medication regardless of your pain level. Do not take other NSAIDs (Aleve, ibuprofen, naproxen, meloxicam) while using this medication.

3. Tylenol - take two (2) extra-strength tablets every eight (8) hours. This will help cut back on the amount of oxycodone that you need.

All of your medications will be electronically prescribed at the time of your preoperative visit. In addition to the pain medications previously discussed, you will need:

1. Baby aspirin (81mg) - take one tablet twice daily for four (4) weeks after surgery to reduce the risk of blood clots

2. Ondansetron (Zofran) - this is an anti-nausea medication. It is common to have nausea related to anesthesia and/or pain medications. Use this as needed.

3. Senna - this is a stool softener. Constipation is a common issue after surgery. Take this (or another stool softener of your choice) until you have normal bowel movements.

You will have an ace wrap/compressive dressing applied at the time of surgery. This helps control the swelling. You may remove this three days after surgery.

The surgical dressing is a special type of incisional wound vac called ‘PICO’. It is a clear plastic dressing connected to a battery pack that applies a small amount of suction to the wound. This helps promote wound healing and prevents the build-up of fluid. The dressing will remain on until your first follow-up visit.

You will not need to perform any dressing changes. However, you will need to disconnect the battery pack when showering (it is ok for the dressing to get wet, but the battery pack is not waterproof).

After one week, the battery pack will die. At this point, you should disconnect the battery pack, but leave the dressing in place.

The incision will be closed with dissolvable sutures beneath the skin. There will be two tiny accessory incisions a little bit below the main incision (these are necessary for the robotic system). These will be closed with a few sutures that are removed at the first postoperative visit.

You will also be provided compression stockings. I recommend wearing these as tolerated for four (4) weeks after surgery. The stockings help reduce postoperative swelling.

You may remove the ace wrap three (3) days after surgery and can begin showering at this point. You will need to disconnect the battery pack when showering and reconnect it afterward.

After surgery, you are permitted (and encouraged) to begin full weight-bearing immediately. For your safety, I recommend using a walker until you regain appropriate muscle control and strength to safely ambulate without assistance. A fall is the worst thing that can happen postoperatively! Some patients are off the walker in a few days, others need it for several weeks. Everyone recovers at a different pace.

In most cases, you will begin working on range-of-motion exercises (bending and straightening the knee) immediately after surgery. In some cases, the knee will be immobilized for a couple of weeks to help protect the incision.

Once the knee has fully healed, you will be able to perform virtually any activities without restriction (that your body tolerates). I recommend against distance running. It is also wise to avoid risky activities like black diamond skiing.

You will come back at two (2) and six (6) weeks after surgery. These visits will be scheduled before the surgery.

The two-week visit will be with our Nurse Practitioner (Crystal Morrow) or Physician Assistant (Maegan Weeks).

At the six-week visit, we will obtain new X-rays to assess the implant position.

I do not give patients a firm timeline, as all patients recover at different rates. However, most patients can drive about 2-6 weeks after surgery. It may take longer after right-sided surgery since that is your driving foot. You will need to be off all narcotic pain medications. I recommend going for a “test drive” around an empty parking lot or another safe area before getting on major roads.

This depends largely on the type of work. For sedentary/desk work, it is often possible to return within one to two weeks, while jobs that require manual labor may take two to three months (or more).