Download Preparing for your Knee Surgery

Preparing
for your
Knee Surgery
Please bring this handbook with you when you are admitted to the hospital.
Table of Contents
Introduction ...................................................................................4
Benefits of Surgery .........................................................................4
Risks of Surgery .............................................................................4
Preparing for Your Surgery...............................................................4
Before Your Surgery ........................................................................5
Pre-admission ................................................................................5
Preoperative Shower/Bath................................................................5
Family/Visitor Information................................................................6
Map ..............................................................................................6
Getting Ready for the Hospital.........................................................7
Admission Process..........................................................................7
Before Surgery ...............................................................................7
Pain Management...........................................................................8
Using Your PCA Pump ....................................................................8
Nausea ..........................................................................................9
Medicine to Prevent Blood Clots ......................................................9
Tubes ..........................................................................................10
Intake and Output ........................................................................10
Nutrition......................................................................................10
Elimination ..................................................................................10
Breathing & Coughing ...................................................................10
Medication Management While You Are at the Hospital....................11
Activity ........................................................................................11
Fall Prevention .............................................................................12
Help Us Take Care of You..............................................................12
Common Devices Used After Surgery..............................................12
Therapy & Activity ........................................................................13
Helpful Hints ...............................................................................14
Home Safety and Specific Items Ideas ...........................................15
Before You Go Home.....................................................................15
Discharge Process ........................................................................15
Take Home Prescription Medication ...............................................16
Incision Care................................................................................16
Daily Activities for a Total Knee Patient ..........................................16
Home Exercise Program ................................................................17
Precautions..................................................................................19
When to Call Your Physician ..........................................................20
6012-0617 JUNE 06
3
Introduction
This handbook is meant to provide you and your family with information
regarding preparing for your total knee surgery and recovery.
Share the information in this handbook with your family.
Benefits of Surgery
»
»
»
»
»
Correct injury
Reduce or eliminate pain
Gain or improve mobility
Gain or increase activity level
Improve quality of life
Risks of Surgery
»
»
»
»
»
»
Respiratory problems (pneumonia)
Blood clots
Nerve damage
Loosening of the knee prosthesis
Fracture or dislocation
An infection can occur after surgery:*
Your intact skin is important protection
from infection. It is normal (and helpful)
for all people to have germs on their skin
and in some parts of their body.
Staphylococcus, commonly called "Staph",
is an example of bacteria all people have
on their skin. Most surgery requires an
incision. This opening in your skin can
allow germs to enter the body. If germs,
including your normal germs, enter the
body through a surgical incision, an
infection might occur. Before the incision is
made, antiseptics will be applied to your
skin to try to kill as many germs as
possible, but it is impossible to remove all
bacteria from skin. Antibiotics may also be
given before surgery to help prevent
infection.
if you are diabetic, obesity, age, weak immune
system, or if you have other illnesses).
What can I do to minimize my risk of infection?
Before surgery, improve your general state of
health as much as possible. For example, be at
an optimal weight and nutritional state. Talk to
your physician about ways to improve your
health.
Preparing for Your Surgery
Part of planning for your surgery should include
planning for your return home after surgery. By
learning how your surgery will affect your life,
you can prepare for assistance at home. You
may be asked to give information that will assist
your caregivers in preparing you for home. You
should consider family, friends, or community
agencies in your aftercare. If help at home is not
possible, arrangements may need to be made to
stay in an extended care facility within your
community for a few weeks. A social worker is
available at the hospital to help you plan your
aftercare.
What are the chances that I get an infection
after surgery?
Any person who has a surgical operation could
get an infection. The risk of infection depends
on the type of operation, how long you must be
in the hospital, and your overall health before
surgery (for example, nutrition, blood sugar level
4
The nurse will tell you when to stop eating,
drinking and give you medication instructions
prior to surgery. You may eat as usual until
midnight the evening before the surgery, unless
advised otherwise by you surgeon. When we
refer to "nothing by mouth" this includes water,
chewing gum, breath mints, cough drops etc.
You may brush your teeth and rinse your mouth
without swallowing liquids. Do not drink alcohol
for at least 12 hours before your arrival. Do not
smoke or chew tobacco after midnight. This is
for your safety. Failure to observe these
requirements may result in delay or cancellation
of your surgery.
Before Your Surgery
A complete medical history/examination is
needed to help your physician and nurse set up
a plan of care. They will ask you questions about
your general health and specific information on
why you are here for surgery.
Physician Visit
Some routine pre-op tests may include: EKG,
chest x-ray, laboratory and tests. You may have
some health problems that make surgery risky.
Examples of these conditions are: obesity, heart
or lung disease, tooth or gum decay, infection
and other health problems.
A nurse will contact you one working day before
surgery to tell you what time to arrive at the
hospital before your surgery. You will be
reminded when to quit eating and drinking.
Tobacco Use
Smoking interferes with your lung's ability to
clear itself of secretions. These secretions tend
to accumulate after surgery and anesthesia. If
these secretions are not cleared, an infection
could result, possibly leading to pneumonia.
Follow your physician's advice about smoking
and tobacco use. Talk to your caregiver about
tobacco cessation information.
Preoperative Shower/Bath with
Chlorhexidine Soap (CHG)
Everyone’s skin normally has some germs
including Staph. Before surgery, you can play an
important role in your own health by reducing
the number of germs on your skin as much as
possible. Carefully washing with a special
antimicrobial soap before surgery will reduce
the number of germs on your skin and decrease
the chance of infection.
Activity Visit
A physical therapist may show you a home
exercise program to do before your surgery to
improve your physical condition. These
exercises strengthen muscles, improving the
movement of your knee. The therapist will show
you how you will have to move after your surgery.
You will need a walker or a pair of crutches to
help you walk after your surgery. If your
physician and therapists feel you need more
help with exercise, you may be referred to
outpatient therapy or a home health agency.
You will be given a bottle of special soap that
contains chlorhexidine gluconate (CHG)**. The
soap is liquid and Altru uses Endure brand. If
for some reason you misplace the soap given to
you, another easy to find brand name soap is
Hibiclens and can be purchased at a pharmacy
or Walmart. If you are allergic to
chlorhexidine** please let your surgeon’s office
know.
Pre-Admission
A nurse will discuss the surgery and recovery
with you and your family. You and a nurse will
talk about past medical history and medications
you take. You may see a film about your surgery.
This is a chance to ask questions and voice
concerns you may have.
WARNINGS
» Do not drink the soap.
» Do not use the CHG near your eyes to avoid
permanent injury.
» Do not use the CHG near your ears to avoid
permanent injury.
5
INSTRUCTIONS
» Shower or bathe with the CHG soap the
night before your surgery and again the
morning of surgery. Using the soap twice
works better one time.
» Apply the CHG soap to your entire body
ONLY FROM THE NECK DOWN.
» Wash thoroughly, paying special attention to
the area where your surgery will be
performed. Try to leave the soap on your skin
for a few minutes before rinsing.
» With each shower or bath, wash your hair as
usual with your normal shampoo.
» Do NOT shave the area of your body where
your surgery will be performed.
» Do NOT use lotion, cream, or powder.
» Wear clean clothes.
**CHG soap should not be used by people
allergic to chlorhexidine.
parking areas are in the front of the hospital. A
patient/family handbook is located in each
waiting area and by each bed which contains
information such as cafeteria hours, dialing
instructions, visiting hours, etc.
Your visitors are also welcome to dine in our
cafeteria or make use of our 24-hour food
vending areas, which are located on the first
level of the hospital.
While you are in surgery, your family will be told
where they can wait.
When you are ready to leave the hospital, your
family member or friend may drive from the
visitor's parking area to meet you under the
front entrance canopy. The nursing staff will
assist you in making these arrangements and
will escort you to the front entrance.
In consideration of everyone's health, Altru
Health System is a tobacco-free institution.
Smoking and other tobacco products are not
permitted on Altru premises. Thank you for your
support in keeping our environment safe and
clean.
Family/Visitor Information
Your friends and family are welcome to visit with
you during your stay at the hospital. The visiting
hours are posted for each department and may
be obtained at the front desk. Visitor and family
6
Getting Ready for the Hospital
Before Surgery
»
After you arrive, your pre-op instructions will
begin. If you have not already been contacted by
pre-admission your nurse will complete your
admission record, and explain our hospital
routines with you. You will put on a gown and
place your clothing in a garment bag. Any lab
work or procedures your physician has ordered
will be done and results obtained before surgery.
Bring comfortable clothes (sweat suits, or
loose clothing are best) and non-skid shoes
to wear once activity has started.
» Personal care products such as shampoo,
comb, brush, etc.
» Short robe (button or snap down the front is
preferred)
» Walker or crutches if you already have them
at home (Please label them with your name.)
If you have not already done so you will be
asked to sign a surgical consent form. This form
gives your surgeon the legal right to do the
surgery and states that you understand the
nature of the operation and any risks that are
associated with this type of surgery. If you have
any questions about the form, feel free to
discuss them with your caregiver.
Admission Process
Upon your arrival at the hospital, you will need
to stop at the registration desk in the front lobby
to be registered. The registration staff will check
you in, update your hospital chart and give you
a hospital ID bracelet. You will then be directed
to the surgical admission center of the Same
Day Surgery Department or a hospital room.
Your family may accompany you throughout the
admission process if you wish.
Altru has initiated the KISS program which
stands for Korrect Identification Surgical Site.
What this means is for any procedure involving
right/left distinction, multiple structures (such
as fingers, and toes) or multiple levels (as in the
spinal procedures), must be marked so that the
mark is visible after the patient has been
prepped and draped for surgery. Your surgeon
will initial the site pre-operatively. You can also
mark the surgical site if you wish. Immediately
before the surgery, your caregivers will verbally
confirm and document that we have the correct
patient, marked the correct site and side, the
correct procedure is being performed and the
patient is in the correct position.
During the admission process to Altru Health
System you can expect that:
» You will be provided an orientation to the
room setup and hospital routines.
» The nurse(s) will be asking you many
questions in order to obtain an
understanding of why you are being
admitted to the hospital and what special
needs you require during your stay in the
hospital.
» You may have lab or x-rays performed.
» You will have nurses and other healthcare
disciplines working with you.
» You may not drink, eat, or take any
medications until the physician orders that
this is permitted.
» You will be weighed, and have your vital
signs and history taken by the nurse.
You will be asked to remove:
» Dentures
» Hair pins, wigs, etc.
» Jewelry, including body piercings
» Glasses, contact lenses
» Nail polish
» Valuables
» Make-up
» All underwear, after receiving your gown
Shortly before going to surgery, you will be
asked to empty your bladder (urinate).
Each nurse cares for multiple patients and
makes every attempt to provide you with what
you need as soon as possible. If you receive care
that does not meet or exceed your expectations
please ask to speak to the charge nurse or
manager.
7
Pain Management
Holding Room
You will most likely go to the Holding Room
about one half to one hour before your operation
is scheduled to begin. The Holding Room is
where your final surgery preparation is
completed. A limited number of family
members may accompany you.
The goal of Altru Health System is for every
patient to be as pain free as possible. You
should expect to feel some discomfort after
surgery. Your level of discomfort will be
evaluated before and after surgery. Keep the
nurse informed about your comfort level after
surgery. Tell the nurse where the pain is located
and how strong it is on a scale of 0-10. Please
feel free to talk to your caregiver about you pain
and pain relief measures.
You will meet your physician and nurse of
anesthesia. They will review your medical
history and explain the anesthesia. This is a
time to ask questions if you have any.
Below are some examples of pain management
methods that may be used.
Before going to surgery, your IV will be started
and you will be given medication intravenously
that will help you relax.
» Pain pills by mouth.
» Through an IV line.
» PCA Pumps: Your physician may order a PCA
(Patient Controlled Analgesia) for you to use
helping to manage your pain.
» Epidural - medication dripped slowly
through a tube into areas of your spine.
Cooling device (Cryocuff): This device sends
chilled water through a pad placed over your
knee.
Operating Room
In the Operating Room you will be aware of
much activity. Anesthesia staff will be with you
monitoring several of your body functions from
the moment your anesthesia starts until after
your operation is done. Surgical nurses will also
be assisting the surgeon. You will have heart
monitor leads on your chest and a blood
pressure cuff on your arm which takes readings
automatically. Both of these procedures are
routine. The Operating Room is cool and
brightly lit.
Using Your PCA Pump
Controlling your pain during recovery is
important. The PCA pump allows you, the
patient, to control the amount of pain
medication you receive. These are safe and easy
to use.
Recovery Room
After surgery, you will go to a recovery area.
Here you will be closely watched as you recover
from your anesthesia. The staff will take many
readings of your vital signs, such as pulse and
blood pressure, until they are certain that you
are ready to return to your room. Family is not
permitted in the recovery area.
Warning to Patient and Family:
NO ONE but the patient should press
the PCA button. Talk to the nurse if you
have questions.
Your Room
Once you are in your room on the nursing unit,
the nurses will continue to take frequent
readings of your vital signs. A patient/family
handbook is located by each bed which contains
information such as room service, dialing out
instructions, billing information, etc.
Pain Control
Pain control helps the natural healing process.
Without the fear of pain, you should feel less
anxious and be able to relax. Pain medications
(including narcotics) are not addictive when the
medication is prescribed for a short time and
stopped gradually.
8
How the PCA Works
With the PCA, you are the key to managing your
pain. Your caregivers will work closely with you.
You will be asked to rate your pain on a scale of
0 (no pain) to 10 (worse pain you can imagine).
Your responses will guide your caregivers in
setting the dosages of pain medication to meet
your needs. Your PCA pump is attached to
medication and tubing which hooks into your IV
line.
Side Effects
Your pain medication may cause some side
effects, which can be eliminated. Tell your
caregiver if you have any of the following:
You will be given a button that is attached to the
pump to push when you need your pain
medication. When you push this button, a set
amount of pain medication will flow into your IV.
Do not wait until your pain gets worst to give
yourself pain mediation. If you wait too long, it
may be difficult to get comfortable again.
Nausea
Occasionally, some people feel nauseated after
surgery. If you feel like vomiting, please tell your
nurse. Medicines may be ordered.
» Nausea
» Difficulty urinating
» Constipation
» Confusion
» Excessive sleepiness
Medicine to Prevent Blood Clots
After surgery you will be started on blood
thinning medication (anticoagulants) that help
prevent clots in your legs. It may be given in
shots or in pills. If you are taking anticoagulant
medication, report any abnormal bleeding to
your physician or nurse immediately!
You may push this button as often as you need
to. The PCA is set up with specific instructions
on how much medication and how often you
receive pain medicine.
The PCA pump lets you decide when you want
to get pain relief. The PCA pump is designed so
that you cannot give yourself too much
medication, protecting you from overdose. If
your pain isn't being controlled let your
caregiver know as soon as possible. They can
change the settings on the PCA pump to help
you get more pain relief.
Examples of abnormal bleeding
» Blood in urine (red or smoky color)
» Nosebleeds
» Excessive bruising
» Blood in stools (tarry or bright red color)
You should wear identification stating that you
are taking anticoagulants or blood thinner
medication. This should continue to be worn for
two weeks after you quit taking the medication.
Pain Scale











0
1
2
3
4
5
6
7
8
9
10
No pain
Some pain
but OK
Mild pain
worse
Annoying
pain
Distracting
pain
Pain can’t
be ignored
for more
than 30
minutes
Pain can’t
be ignored
at all
Pain makes
it hard to
think and
sleep
Pain limits
activity;
nausea
with pain
I cry out in
pain
Passed out
© 2000 Permission by Pritchett & Hull Associates, Inc.
Used with permission. Cannot be duplicated.
9
Tubes
Bowels
You will be on a liquid diet right after surgery,
with more choices as your appetite improves. By
the second day your bowel function should start
to get back to normal. If constipation becomes
a problem, tell your nurse, as a laxative, stool
softener, or enema may help. Drink plenty of
fluids including juice and eat fruits, vegetables
and bran.
After your surgery, you may find a tube or tubes
attached to your body. The number and reasons
for the tubes depend on the type of surgery you
have had. You may have:
»
An intravenous line (IV). This carries fluids
or medications to your body until you are
able to take them by mouth.
» A catheter to drain urine from your bladder.
» A wound drain in or near your surgery
incision that is attached to a suction source.
» A tube to your stomach (NG) entering
through your nose to keep your stomach
empty.
Breathing and Coughing
Deep Breathing
1. Hold both hands over your lower rib cage.
2. Breathe in as deeply as possible through your
nose, moving your rib cage out as you
breathe.
3. Breathe all the air out slowly through your
mouth, pursing your lips as if you were
blowing out a candle. You should feel your
ribs move in.
4. Repeat five times with a short rest between
each breath.
5. Do this every 2 hours while you are awake.
I & O (Intake and Output)
Your nurse will need to keep an accurate record
of the fluids you drink and/or receive through
your IV. Since an accurate record of urine will
also be kept, please use the bedpan, urinal or
the toilet seat-measuring pan when using the
bathroom. Your nurse will empty and record the
amount of urine in your records. A record of I&O
will be kept until your nurse tells you it is no
longer necessary. You can assist your nurse by
informing them of the fluids you drink.
A device called an incentive spirometer may be
ordered to help you take deep breaths. Deep
breathing can help prevent pneumonia or other
problems that could slow your recovery.
Coughing
1. Take a slow, deep breath into your lungs,
through your nose and hold it.
2. As you breathe out, cough deeply twice from
your lungs, making "Ha, Ha" sounds with
your mouth slightly open.
3. Repeat this every 2 hours while you are
awake.
Nutrition
You will be given liquids to drink when your
stomach "awakens" after surgery. If you are not
having nausea, you will be started on your
normal diet.
Elimination (Toileting)
Void
As mentioned earlier, the tube (urinary catheter)
in your bladder may be removed in 1 to 2 days.
Once removed, you can use a bedpan, the
commode, or bathroom when you need to void.
10
Walking
Medication Management While You
are at the Hospital
1. You will be kept in bed until you physician
allows you to get up. The nurse will teach
you the proper procedure to get you out of
bed. If you need more assistance, please call
your nurse.
2. Walk as directed by your physician and
nurse.
»
Share with physician, surgeon and
healthcare professionals a list of your
current medications, vitamins, herbals and
supplements.
» Make sure the physician or nurse checks
your wristband and asks your name before
giving you medicine.
» Ask your physician or nurse how a new
medicine will help. Ask for written
information about it, including its brand
name and generic name.
» Ask your physician or nurse about the
possible side effects of your medicine.
» Don't be afraid to tell the physician or nurse
if you think you are about to get the wrong
medicine.
» Know what time you normally get a
medicine. If you don't get it then, tell your
physician or nurse.
» Tell your physician or nurse if you don't feel
well after receiving a medicine. If you think
you are having a reaction or experiencing
side effects, ask for help immediately.
» If you are not feeling well enough to ask
questions about your medicine, ask a
relative or friend to ask questions for you
and to help you make sure you get and take
the right medicines.
Before you leave the hospital, make sure that
you understand all of the instructions for the
medicines you will need to keep taking, and ask
any questions
Fall Prevention
Why You Might be at Risk for Falls While in the
Hospital
» Bedrest - staying in bed can make your
muscles shrink and lose strength. Also, after
you get up from lying down, low blood
pressure may make you dizzy.
» Being in a new environment - it is more
common to fall when you are in unfamiliar
surroundings. It may also make it more
difficult for you to rest, making you more
susceptible to falling.
» The normal aging process - as we get older,
normal age-related changes like slower
reflexes, weak or brittle bones, stiff joints,
and decreased vision can make you more
prone to fall.
» Always ask for help if you feel dizzy,
disorientated, or confused.
Be Aware of the Bathroom Risk
One of the most common situations in which
falls occur involves getting to or from the
bathroom or trying to use a bedside commode.
This may be due to the fact that most of us view
toileting as a very private function and may not
want to ask for help, even when we need it. Or
we may be unwilling to wait for help to arrive.
Activity
»
Once you are awake you will be shown how
to do exercises in bed.
» You will be assisted into a chair the day of
surgery or day after surgery for meals and
short periods of time.
» You will be taught how to pivot into a chair
with a walker.
How to Stop Falls
You can avoid a fall by working with your
healthcare providers, asking them to help when
you need it, and following a few reminders:
» Use handrails or grab bars
» Get up from a lying position slowly
11
»
You may be asked not to walk or to get up
without staff assistance.
» We may need to ask your family/friends or
our staff to sit with you if you become
restless and frequently forget to call for help
before getting up.
» Physical therapy may be ordered to assist
you in gaining strength and mobility if
needed.
»
Wear shoes or slippers with non-skid soles
when you walk (don't walk in nylons or socks
on non-carpeted floors)
» Use call lights for assistance - they are
located at your bedside and in the bathroom
» Keep bedside table and things you need
within easy reach
If You Do Fall
» Stay calm. It may feel embarrassing or scary
to fall, but most falls are not serious.
» Call for help. If you can reach it, use your
call light and call out for help.
» Don't get up on your own. Stay where you are
until help arrives - you might be injured.
» Report any symptoms of pain or injury to
your caregivers.
Help Us Take Care of You
»
Look for our name badge. Expect us to
introduce ourselves. We want you to know
who we are.
» Remind us if we forget to wash our hands or
use a hand sanitizer before we treat you.
Clean hands help to keep you safe.
» Expect us to ask your name and read our
wristband before we treat you or give you
medications. If we don't ask, please tell us.
Did you know one of the leading adverse events
in healthcare facilities today is falls, and that
your risk of falling increases with your age?
Common Devices (aides)
Used After Surgery
Nurses will be assessing you frequently for your
risk of falling. Your nurse will consider the
following to assess your potential for falling:
Compression stockings and/or TED hose may be
applied to your legs before and/or after surgery.
The stockings or hose will help to improve blood
circulation to the lower legs preventing blood
clots. If either the compression stockings or
TED hose feel tight or uncomfortable, please
inform your nurse.
»
»
»
»
»
»
History of a fall in the last six months
Unsteady walk
Confusion or disorientation
Frequent need to go to the bathroom
Your medical condition - fatigue or weakness
Medications you are taking - some of them
alone or in combination may make you feel
light-headed, dizzy, or drowsy.
» Any time you have had a procedure when
anesthesia is given, or if you are moved to a
new nursing unit.
Continue wearing your TED hose at home until
your physician says you don't need them. Take
the TED hose off for at least 1/2 hour twice a
day. Bathe the skin and inspect the
dressing/incision during this time. Inform your
physician if you see any redness or feel any sore
areas on your leg.
Depending on your level of fall risk, certain
precautionary measures may be implemented.
These may include:
»
Trapeze Bar
The trapeze bar above your head is there to
assist you in moving about while you are in bed.
Use only your unaffected leg (the leg on which
you did not have surgery) to lift yourself.
A bed alarm may be placed on your bed this will sound as a reminder to you to not
get out of bed without assistance. This also
alerts caregivers.
12
Knee Machine
Your physician may or may not prescribe a
machine to bend and straighten your knee. The
name of this machine is a Continuous Passive
Motion Machine (CPM). You may be allowed to
lie on your side with your leg out of the machine
once a day/night for 1-2 hours.
in the hallway with nursing staff. Your therapist
will progress you to walking with crutches when
ready. You will also be shown how to walk up
and down stairs before you are discharged.
During your hospital stay, you will continue with
the exercise program as you prepare to go home
and will continue it when you get home. Some
patients may require additional physical or
occupational therapy at a rehabilitation facility.
Your physician or therapist will discuss possible
options with you.
Occupational Therapy
After surgery you may be seen by Occupational
Therapy. In preparing you to go home, they will
assist you with increasing your endurance and
function for independence. The following
instructions/activities will be given:
»
The correct methods for putting on/taking off
clothing within precaution levels for your
new total joint.
» Meal preparation methods with use of
walker/crutches will be trialed and/or
discussed with you.
» The correct methods for getting in and out of
bed, up and down from the toilet and chair
and in and out of the car.
» The use of assistive aides can improve your
independence and safety, such as toilet
risers, grab bars, shower chairs, assistive
dressing equipment, etc. Your therapist will
recommend assistive aids to help you when
you go home.
» Your home program will be reviewed with you
and your caregivers.
CPM Machine
Knee Brace
Your physician may order a knee brace
(immobilizer) used to help straighten your knee
for short periods of time.
Therapy and Activity
Exercises and Physical Therapy
After surgery, you will receive physical therapy
at your bedside twice daily. You will start the
exercises as soon as the afternoon of your
surgery, or the following morning with the
therapist’s assistance. You will be asked to do
the exercises on your own during the day, as
well as when the therapist is present.
If you have crutches or a walker bring them with
you so that they can be adjusted to fit you
properly. Be sure to label them with your name.
Movement Restrictions
To avoid injury to your new knee, you must
remember the following:
You may begin walking with a walker and
assistance as soon as the first day after surgery.
You will be instructed in the proper way to get
up and sit on the side of the bed. When you are
ready to walk you may walk to the bathroom and
»
Adhere to your specified weight bearing
status and walk as you were taught in
physical therapy.
» Do not kneel or squat on your surgical knee.
» Do not pivot on the surgical knee. When you
turn, take mini steps.
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» Do not force your knee to bend.
» Do not cross your legs at the knees or ankles.
» When you sit down, slide your surgical leg
forward out in front of you before sitting
down.
» Sit down easily; do not “plop” into a chair.
»
Helpful Hints
» Discuss plans about returning to work with
your physician.
» Check with your physician before making
plans for lengthy trips. Your metal prosthesis
may set off security alarms at airports.
» Before minor surgery, dental work, or
procedures (i.e. cardiac cath, bladder exam,
etc.), remind your physician or dentist that
you have a prosthesis. Antibiotics may be
needed to prevent infection.
» Keep your appointments with your
physician.
» Discuss with your physician exercise
activities you would like to do. Your
physician may suggest low impact exercises
like walking, dancing, bike riding and golf.
» Call your physician if you have any signs of
infection (urinary infection, abscessed teeth,
etc.), as early treatment is needed. Your new
knee is a foreign item in your body. Germs
from other parts of your body may move to
your new knee and cause infection.
»
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»
Home Safety and
Specific Items Ideas
»
To prevent falls, remove or watch out for:
- Scatter rugs on floor
- Electrical cords, phone cords, etc.
- Pets that run in your path
- Water spills on floors
- Slippery floors
- Ice or mildew on outdoor steps
» Sit on a kitchen stool or chair with your
surgical leg out when doing countertop
tasks.
» Some ways to carry items from place to
place:
- Use a utility cart with wheels, pushing
it ahead of your walker. This will free up
your hands and reduce the number of
trips you make to complete a task.
- Use a back pack, fanny pack, apron
with many pockets or a walker basket or
bag.
Slide objects on a tray along the countertops
rather than carry them.
Carry hot liquids in containers with lids.
Use a reacher to grab objects on the floor.
Entry to your home:
- Hand rails on all stairways should be
installed if there are none.
A toilet seat riser or portable toilet rails can
be installed to help with moving in the
bathroom. Your bathroom should be
accessible with your walker.
Make sure you have enough room to
approach the side of the bed with walker or
crutches - approximately 2½ - 3 feet.
Kitchen table:
- Have someone pull your table closer to
your counter to allow you to reach from
your counter area directly to your table.
(You will not be able to carry anything
when you use your walker or crutches.)
- Re-arrange frequently used kitchen
items within easy reach.
- Use pre-fixed meals, such as TV
dinners or Meals on Wheels services,
always plan to keep preparation simple.
- You will need help with heavy cleaning
tasks, i.e. vacuuming, washing floors,
stripping beds, etc.
These preparations will make your return home
easier.
You will be learning techniques during your
hospital stay that are important for you to follow
when doing daily activities. It will be very
important that you do as much as possible for
yourself during your hospital stay, as well as
when you are discharged. Your caregiver will be
there to monitor and guide you, but should allow
you every opportunity to regain your
independence as soon as possible.
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Before You Go Home
Discharge Process
On the average, most patients are able to return
home in about four days, or once you are safe
doing activity and self cares or have a caregiver
to help if needed. The recovery period will
depend on your health. You must continue to
follow the instructions given to you for several
months to get the total benefit of your new knee
joint.
During the discharge process at Altru Health
System you can expect that:
You will go home when your medical status is
stable and:
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»
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»
»
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You get good pain relief when you take pain
pills.
You are able to bend your knee at the range
your physician recommends.
You are able to move without help: in and
out of bed; in and out of chairs; and on and
off the toilet.
You are able to care for yourself.
You are able to walk on level surfaces when
using your walker or crutches.
You are able to walk stairs (with help) using
your walker or crutches.
You are able to do your exercise program on
your own.
»
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Your physician must see you first and then
decide when you may go home.
The discharge time may be determined by
criteria set by your physician.
Your nurse will instruct you on the discharge
process and paperwork necessary.
A plan for your discharge medications and
follow-up appointment will be made.
Arrangements need to be made for your take
home medications and other supplies.
Other Altru Health System disciplines may
need to visit you and assist in your
discharge.
Your belongings will be packed with your
assistance if able
Altru Health System staff must escort you to
the lobby front door.
Frequent asked questions:
» Do I need to restrict activity such as
housework or childcare?
» How much can I lift?
» Can I drive a car?
» When can I drive?
» When can I resume sexual activity?
» What about sports?
» Do I have a special diet?
» What kinds of medication do I take? What
side effects are possible?
» Will I need help at home?
» What are the supplies that I may need?
Where can I get them?
» Who do I call if I have questions when I get
home/
» When and how can I bathe/shower?
If you are unable to do any of these things, your
caregiver will be taught to help you at home. If
you have no one to help you at home, a social
worker can help you make discharge plans.
Your first check-up appointment will be
arranged for you. At this appointment, your
physician will see how your new knee is healing
and how you are able to move it. A physical
therapist may be asked to re-check your joint
functions and your muscle strength. These
appointments are made to detect any problems
you may have, so keep all arranged
appointments.
Tips for managing pain at home:
» Take your pain medication routinely as
directed by your healthcare provider. This
will help keep your pain under control.
» It is important to take your pain pills with
food to prevent nausea.
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Daily Activities for the
Total Knee Patient
»
Follow
your
healthcare
provider's
recommendations for ice, elevation, rest,
etc.
» Listening to music, watching television or
videos may help distract you from your pain.
Sitting
Sitting may be easier if you sit on a chair that is
not too low, allowing your hips to be higher than
your knees. It may also be more comfortable to
elevate your operated leg to decrease swelling.
You have no restrictions on bending forward at
the hip.
Take Home
Prescription Medication
Your physician may order a prescription
medication for you after your surgery. You will
have the option of purchasing your medication
at Altru's Retail Pharmacy or taking your
prescription to a pharmacy of your choice.
Altru's Retail Pharmacy accepts cash, checks or
credit cards. Altru's Retail Pharmacy is located
on the main level of the hospital. Please bring
your insurance card with you.
Lying In Bed
Do not put a pillow under your leg because this
may cause stiffness in your hip and knee,
making it difficult to straighten your leg.
Tub Transfer
We suggest you use a chair in the tub for a
sitting shower, or that you sponge bathe. There
should be a rubber mat or a nonskid surface on
the tub floor to prevent slipping.
Phone: 701.780.3444
»
Hours of operation:
Monday-Friday, 9 a.m. - 7 p.m.
Saturday & Sunday 9 a.m. - 6 p.m.
»
Incision Care
»
» Inspect your incision every day at home.
» Keep your incision clean and dry to prevent
infection.
» If you have staples or sutures in place, do
not get your incision wet.
» You may change the dressing (as shown to
you in the hospital) if it becomes soiled or
falls off. Wash your hands before changing
the dressing.
» If you go home with staples in place, ask
your physician when the staples should be
removed. Plan this around two to three
weeks after surgery.
» Report any drainage from the incision and
any excessive swelling, fever, redness,
increased pain, or change in skin color or
temperature around the incision.
»
»
Using the walker, back up to the side of the
tub, stop next to the chair.
Reach back with one hand for the back of
the chair and the other hand should remain
on the walker.
Sit down on the chair, keeping operated leg
out, lift legs over the side of the tub and turn
to face the faucet.
You may wash and dry yourself while sitting
in this position.
To transfer out of the tub, turn in the chair
while lifting your legs over the side of the
tub. Pushing off from the chair, stand up
outside of the tub.
Note: You may want to consider installing a
bathtub safety rail or grab bar as well as using a
long-handled sponge and a handheld shower
nozzle to increase safety during bathing.
Remember to get your physician’s permission
before bathing or getting down into the tub.
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Home Exercise Program
Shower Transfer
You may choose either to stand or to use a chair
in the shower. There should be a rubber mat or
nonskid surface on the floor to prevent slipping.
We recommend that you walk into the shower
with your walker for safety. Place the walker in
the shower stall and bring your operated leg over
the lip of the shower. Then bring your nonoperative leg into the shower. Position yourself
either standing or sit on a chair. Remember: You
should shower only when your physician gives
you permission.
Do all exercises slowly; do 3 times a day.
Do exercises until your recheck with your
surgeon (4-6 weeks).
1. QUADRICEPS SETTING:
Place a rolled up towel under your knee.
Tighten the quadriceps muscle in the front
of your thigh by pushing the back of your
knee downward against the towel roll.
Attempt to straighten your leg. Your heel
should come up slightly from the bed. Do
this exercises slowly and hold 5seconds.
Repeat 10-15 times.
Toilet Transfer
With or without a raised toilet seat: back up to
the toilet until you feel the back of your knees
touching it. Keep one hand on the walkers
middle bar, while reaching back for the edge of
the raised seat with your other hand. Reverse
the procedure for getting up by placing one
hand on the walker and the other hand on the
raised seat. Remember: Have your balance
before grabbing onto the walker with your other
hand. Do not use your walker to pull yourself up.
2. HAMSTRING SETTING:
Tighten the hamstring muscle in the back of
your thigh by digging your heel into the bed.
Allow your knee to bend very slightly. Do this
exercise slowly and hold this position for 5
seconds. Repeat 10-15 times.
Car Transfer
» Back up to the car with your walker.
» Lower yourself slowly to the seat.
» Slide back into the car far enough to allow
room to bring your operated leg into the car
with ease, placing a large plastic garbage
bag on the seat, to assist you in.
» Do not drive without your physician’s
permission.
Sliding into the car as
far as possible
supports your leg.
Carefully lift your leg
into your car.
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3. STRAIGHT LEG RAISE:
Keeping your knee straight, slowly raise your
leg off the bed. You may bend the opposite
knee as this will support your back and allow
you to perform the exercise more easily.
Raise leg to the height of the opposite knee.
Let leg down at a slower speed than you
raised it up. Repeat 10-15 times.
7. KNEE RANGE OF MOTION:
Sit in chair, may put rolled towel under knee
if needed. Slowly bend and straighten
involved knee. Repeat 10-15 times.
4. HEEL SLIDING:
Lie on back. Slowly, bend the knee, sliding
the heel up to the opposite knee. Repeat 1015 times.
5. HIP ABDUCTION:
Keep ______ leg straight and toe pointing to
ceiling. Swing entire leg out to the side. If
your physical therapist allows it, use ______
lbs. on the ankle.
Repeat 10-15 times.
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Precautions
DON’TS
» Don’t jump or run on your new knee.
» Don’t force your knee to bend, but bend it
actively and naturally.
» Don’t apply heat directly to your knee until
tissues heal and swelling is minimal.
» Don’t place a pillow under your knee for a
long period of time, especially when lying on
your back during sleeping or resting periods.
» Don’t walk without assistive devices until
your knee is stable and strong enough
(usually at your physician’s discretion).
» Don’t rotate your knee in or out, particularly
when walking or doing your exercises. Try to
keep your knee pointed straight ahead.
» Don’t walk on uneven or rough surfaces
(gravel, open fields, etc.).
» Don’t kneel on your operated knee.
»
Don’t cross your legs.
Don’t pivot or twist on your operated leg.
DO’S
» Do continue your exercise program at home.
» Do walk cautiously.
» Do gradually increase the speed and
distance of your walking.
» Do return to clinics and physical therapy as
scheduled.
» Do keep operated leg in line with your body
when you walk.
» Do use your walker or crutches until your
physician advises otherwise.
Don’t cross your legs.
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When to Call Your Physician
If you experience:
» Fever
» Increased pain not relieved by medications
or rest
» Increase in swelling not relieved by elevation
and ice
» Redness or drainage from the wound
» Severe nausea
» Shortness of breath or trouble breathing
» Chest congestion
» Chest pain
» Abnormal cough
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