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Lahey Clinic Department of Orthopaedic Surgery
A Patient’s Guide to
Department of Orthopaedic Surgery
41 Mall Road • Burlington, Massachusetts 01805
(781) 744-8650
See The Department of Orthopaedic Surgery at www.lahey.org
KNEE
REPLACEMENT
A Patient’s Guide to Knee Replacement
Dear Knee Replacement Patient,
We hope this Patient Guide to Knee Replacement provides valuable information as you
prepare for your knee replacement operation. More information about the Lahey Clinic
Department of Orthopaedic Surgery is available at www.lahey.org/OrthopaedicSurgery.
Enjoy your new knee!
Lahey Clinic Knee Replacement Surgeons
(Left to right)
Brian J. Jolley, M.D., Stephen E. Lemos, M.D., Richard Iorio, M.D.,
John F. Tilzey, M.D., William L. Healy, M.D., Richard M. Wilk, M.D.,
Michael S. Thompson, M.D., Lawrence M. Specht, M.D., Mark J. Lemos, M.D.,
Bernard A. Pfeifer, M.D.
If you have any questions or concerns about your knee replacement operation,
please call your Orthopaedic surgeon at Lahey Clinic, (781) 744-8650.
A Patient’s Guide to Knee Replacement
• Stay active and bear weight on your reconstructed knee.
• Airline travel within the first 2 months after knee
replacement operation increases the risk of developing a
blood clot. Please discuss this with your surgeon.
Walking is an essential part of physical therapy. You
should take daily walks, lengthening your walking distances as
your strength improves.
FOR THE REST OF YOUR LIFE
Your knee replacement should provide mobility, stability,
and pain free function for many years. You can participate in
many activities with your “new knee”. However, you should
protect your knee replacement from excess stress which can lead
to premature failure of the artificial joint. Avoid weight gain
which will increase stress on your new knee. High impact
loading activities such as jumping, running, jogging, and heavy
weight lifting should be avoided. Sports, such as basketball,
racquetball, squash, volleyball, and tennis, increase the risk of
implant loosening and implant wear. You may choose to
participate in these sports, but you must accept the associated
risk. Low-impact loading activities such as walking, boating,
cycling, swimming, bowling, and golf are excellent activities for
recreation and exercise after knee replacement.

CONTENTS
Choosing Knee Replacement ..............................................2
What is a Knee Replacement? ............................................3
Types of Knee Replacements ..............................................4
Innovation, Technology, and Information ..........................5
Getting Ready for Surgery ..................................................6
Scheduling Your Operation ................................................6
Informed Consent ..............................................................7
Academic Medical Center ..................................................7
Physical Examination/Tests ................................................7
Blood Management ............................................................8
Case Manager......................................................................9
Anesthesia ..........................................................................9
Personal Preparations For Surgery ......................................9
Physical Therapy ..............................................................12
Final Pre-operative Visit ....................................................14
Day Before Surgery ..........................................................15
Operation and Hospital Stay ............................................16
After Surgery: Day by Day ................................................17
Leaving the Hospital ........................................................23
To Rehabilitation Facility ..............................23
To Home ......................................................23
Important Information As You Leave Lahey Clinic ..........24
Follow-up Visits ............................................24
Knee Range of Motion ..................................24
Wound Care ..................................................24
Toileting ........................................................25
Bathing..........................................................25
Dressing ........................................................25
Compressive Stockings ..................................25
Driving ..........................................................26
Sexual Relations ............................................26
Dental Work..................................................26
Infections ......................................................26
Guidelines After Knee Replacement ..................................27
For the First Two Months ..............................27
For the Rest of Your Life................................28

CHOOSING
KNEE
REPLACEMENT
Knee replacement is an elective surgical procedure. This
operation is one of several non-surgical and surgical options which
are available for treatment of your arthritic knee. It is important
for you to be familiar with all possible treatments for your knee.
Non-operative treatment options for an arthritic knee include:
anti-inflammatory medicine, pain medication, physical therapy,
weight loss, walking aids such as a cane or crutches, nutritional
supplements, injections, and restricting your activities. Many
patients with arthritic knees try non-surgical treatment before
choosing surgical treatment.
Surgical treatments for an arthritic knee include: arthroscopy,
osteotomy, fusion, partial knee replacement, and total knee
replacement. Each operation has specific indications, and all
surgical treatments are not appropriate for all patients.
Generally, knee replacement is very successful. Knee pain is
relieved, deformity is corrected, and function improves. It is not
clear how long a knee replacement will last. The long-term success
rate will vary, depending on your age, your weight, and your
activity. “Plan on ten to fifteen years and hope for twenty”. If a knee
replacement becomes loose or wears out, generally it can be fixed
with a revision knee replacement operation.
2
Knee replacement is major surgery. When choosing to have a
knee replacement, it is important to be aware of potential risks
and complications such as: problems from anesthesia, bleeding,
damage to nerves or blood vessels, instability, dislocation,
fracture, ligament injury, blood clot, infection, and very
rarely, death.
GUIDELINES AFTER KNEE
REPLACEMENT
For your safety, and to ensure a successful outcome following
your knee replacement operation, you should adhere to the
following guidelines.
FOR THE FIRST TWO MONTHS
• Push to gain maximum
range of motion during
the first four weeks
following surgery. Knee
motion is critical to the
success of this operation.
• During the day time get
up every half-hour or so
and take a brief walk.
Prolonged sitting may
allow muscles around
your knee to get stiff.
• Avoid slippery surfaces
which may allow your leg to give way.
• When sleeping, do not place a pillow under your knee.
This will prevent you from gaining full extension
(straightening) of your knee. Try to sleep on your back
with a towel roll under your ankle.
• When your surgeon prescribes strengthening
exercises, work hard to make your hip and knee
muscles strong.
27
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3
TYPES OF KNEE REPLACEMENTS
Toileting
Total Knee Arthroplasty (TKA)
Most home toilet seats are low. A commode or raised toilet
seat will be helpful. Toilet grab bars may also be helpful.
Total Knee Arthroplasty or Total Knee Replacement is the
operation described in this booklet. TKA can be a fixed bearing
knee replacement or a mobile bearing knee replacement. The
goal of TKA is to relieve pain and improve function. TKA is the
most common type of knee replacement.
Unicompartmental Knee Replacement (UKA)
Unicompartmental Knee Arthroplasty or Unicompartmental
Knee Replacement resurfaces part of the knee joint. This
operation may also be called a partial knee replacement.
Either the medial (inside) or the lateral (outside) tibiofemoral joint is resurfaced. This operation is less common
than total knee replacement.
Minimally Invasive Knee Replacement
(Minimal Incision/Less Invasive) A Minimally Invasive Knee
Replacement operation (TKA or UKA) is performed through
a small incision with less tissue dissection. Some patients are
not candidates for minimally invasive knee replacement.
Revision Total Knee Arthroplasty
Revision total knee arthroplasty is an operation which revises
or fixes a knee replacement which has developed a problem
such as loosening of fixation, wear of bearing surfaces,
fracture, or instability.
Bilateral Total Knee Arthroplasty
Some patients with two equally symptomatic arthritic knees
may be candidates for Bilateral TKA on the same day.
4
Bathing
While your skin staples or sutures are in your knee incision,
please use sponge baths for personal hygiene. Please do not get
your knee replacement wound wet. You may shower or bathe
after your skin staples or sutures are removed. Bathing is
best done in the shower – getting in and out of a tub can be
difficult and dangerous when recovering from knee surgery.
Grab bars in the shower/tub area may be helpful. A longhandled sponge, can be helpful for bathing your lower body.
Some patients find a tub seat in the shower to be helpful. Be
cautious when walking on slippery bathroom floors.
Dressing
Some patients will need assistive devices in order to dress
independently. A stocking aid may enable you to put on your
socks without bending over too far. A long-handled shoehorn
will assist you in putting on your shoes. Long-handled
reachers may assist you in putting on and pulling up your
pants. You will be evaluated during your hospital stay for your
particular needs at home.
Compressive Stockings
The white TED stockings should be worn on both legs when
you are up during the day. They help control swelling in your
legs (especially in your operated leg). At night, you can remove
them and launder them, if necessary. Usually, you will be asked
to wear these stockings for four to six weeks after surgery.
25
IMPORTANT INFORMATION AS
YOU LEAVE LAHEY CLINIC
INNOVATION, TECHNOLOGY, AND
INFORMATION
Follow-Up Visits
Total knee arthroplasty uses anatomically designed implants made
of high grade biomaterials to resurface arthritic knee joints. As new
materials, designs, and techniques are developed to improve knee
replacement, Lahey knee surgeons evaluate new technology for
possible use with Lahey patients. Lahey Clinic orthopaedic
surgeons use the best techniques and best implants available to
provide predictably successful knee replacement operations.
Two Weeks:
Usually, your surgeon or his assistant will see you in the outpatient
clinic to remove skin staples or sutures two weeks after surgery. If
you go to a rehabilitation hospital, they may remove your staples
or sutures.
Four to Six Weeks:
Usually, you will see your surgeon four to six weeks following
surgery for a clinical and radiographic examination.
Knee Range of Motion
It is your responsibility to achieve a full, functional range of
motion from 120˚ flexion (bend) to 0˚ extension (straight). Your
surgeon, your therapist, CPM machines, and your family will
help, but ultimately, each knee replacement patient must
achieve knee motion by him/herself.
Please do not put pillows under your knee in slight flexion to be
comfortable. This will slow your therapy. When resting put your
knee in a maximum flexion or maximum extension position.
Wound Care
24
Keep your incision dry while staples are in. You should keep a
dressing on your wound if there is drainage. If the wound is clean
and dry, you can leave it open to air. Look at your wound each
day. If you notice signs of possible infection such as: increasing
redness, increasing warmth, or new drainage that looks like pus,
call your surgeon immediately. If your doctor or nurse want to
give you an antibiotic for your knee, please ask him/her to call
your surgeon first.
Innovations that may be appropriate for some patients include:
• modular knee replacement
• all polyethylene tibial implant
• mobile bearing knee replacement
• bilateral knee replacement
• minimally invasive knee replacement
• computer assisted surgical navigation
Information on total knee arthroplasty is
available from many sources including the internet and direct-toconsumer marketing programs. Some of this information is accurate
and useful. Some of this information is not accurate. Information
on clinical services, educational programs, and orthopaedic
research in the Lahey Clinic Department of Orthopaedic
Surgery is available at www. lahey.org/OrthopaedicSurgery.
The Lahey Clinic hospital is a “high reliability organization”
committed to patient safety and prudent use of new “cutting edge”
technology in caring for our patients.
All Lahey Clinic hospital rooms are private rooms equipped with
flat screen personal computers which provide knee replacement
patients with access to television, radio, games, music, email, and
the internet.
5
GETTING READY FOR SURGERY
LEAVING THE HOSPITAL
Once you have decided to have your knee replaced, there is
much to do to prepare for your operation. Lahey Clinic
provides a team approach to your care. You will have a
chance to meet members of the team before surgery. They
will answer your questions and make arrangements to insure
that your surgery, hospital stay, and post-operative recovery
will go as smoothly as possible.
To a Rehabilitation Facility
SCHEDULING YOUR OPERATION
Surgical scheduling is a complex process. Your operation
requires you, your surgeon, an anesthesiologist, surgical
assistants, nurses, an operating room, surgical instruments,
knee implants, and many pieces of equipment to be in the
same place at the same time. You will work with a surgical
scheduler to select an acceptable date for your knee
replacement operation. Please be as flexible as possible in
working with your surgical scheduler.
INFORMED CONSENT
If you choose to go to a rehabilitation facility, and if your health
plan approves this choice, you will be discharged on the second
or third day after surgery. Your case manager will assist you and
your family with discharge plans. You will bring a Lahey Clinic
Knee Replacement Post Acute Care Plan with you to the
rehabilitation facility. Follow-up with your surgeon will also be
arranged.
To Home
If you are medically stable, independent with walker/crutches/
cane, and knowledgeable in knee replacement precautions, and
if you have help available at home, you may choose to be
discharged to home. Your case manager will assist you and your
family with discharge plans. Physical Therapy at a therapists
office or at home will be arranged. You will take pain
medication and blood thinners at home. Usually, you will
resume your routine medications at home – review these
medications with your primary care physician.
You will be asked to sign an informed consent document which
gives Lahey Clinic and the Lahey Clinic professional staff
permission to give you a knee replacement operation. This
booklet will teach you about knee replacement so you will be a
well informed patient. You will also be asked to give Lahey Clinic
permission to collect information about your knee replacement in
the Lahey Clinic total joint database.
6
23
Postoperative Day #4
ACADEMIC MEDICAL CENTER
- Your knee range of motion will be measured and
charted.
Lahey Clinic is an academic medical center. Lahey Clinic doctors
teach residents, students and post graduate fellows how to be
doctors and surgeons. Boston University orthopaedic surgery
residents train at Lahey Clinic. You will meet the students,
residents and fellows as members of the orthopaedic team.
Orthopaedic residents and fellows will participate in your
operation to help your surgeon and learn about knee replacement.
Students and visiting doctors may observe your operation. Your
orthopaedic surgeon will do your knee replacement operation.
- Continue all motion and strengthening exercises
PHYSICAL EXAMINATION/TESTS
- Practice independent transfers.
Generally, a physical examination by an internal medicine doctor
is recommended to ensure that you are healthy enough to
undergo major surgery. If you are new to Lahey Clinic, or if you
have a primary care physician outside Lahey, please bring a letter
from your doctor to your pre-operative visit which describes your
past medical history and your current medical condition.
Consultation with other medical specialists may also be necessary.
Several diagnostic tests, including chest x-ray, EKG, and blood
and urine tests may be scheduled. You need to bring a list of all
your current medications, including prescription drugs, over the
counter medicines, vitamins, herbs, and nutritional supplements
when you come for your preoperative visit. An up-to-date medical
history which includes current and past health problems, allergies,
hospitalizations, and surgeries will be recorded. If you have dental
problems, please inform us and
seek appropriate care well before
your surgery date. Dental
infection can lead to knee
infection.
• The dressing on your wound will be changed. If your
wound is dry, it may not be necessary to cover it.
• The CPM machine will be advanced to gain motion.
• Physical therapy continues:
- Practice independent ambulation with
crutches/walker.
- Practice stair climbing.
- Review knee safety precautions.
Lahey Clinic
Physical Therapy Department
ROM DATA GRAPH
Degrees
120
110
100
90
80
70
60
50
40
30
20
10
0
1
2
3
4
5
Post-operative Day
22
flexion (bending)
extension (straighten leg)
6
7
8
9
10
11
12
13 14
your own
motion!
ChartChart
your
own
motion!
7
BLOOD MANAGEMENT
Most patients who have one knee replacement will not
require blood transfusion. A tourniquet is placed on your
thigh to prevent blood loss during the operation. However,
you will lose blood into your knee and leg after the operation
when the tourniquet is removed.
Some patients will require a blood transfusion after knee
replacement. Factors associated with a need to transfuse blood
include; a low hemoglobin or hematocrit (“low blood count”)
before operation, cardiac conditions, medical disease,
extensive knee reconstruction, unexpected post-operative
blood loss, and bilateral knee replacements on the same day.
In some cases, your surgeon may ask you to donate your own
blood for possible transfusion – autologous transfusion. This
blood is refrigerated and stored until the time of your
operation. If transfusion is necessary, you will be transfused
with your own blood. In some cases, on the day of your
surgery, your anesthesiologist may draw off some of your
blood before the operation in order to give it back to you after
surgery – hemodilution. In some cases it may be necessary for
you to be transfused with Blood Bank blood.
Postoperative Day #3
• The dressing on your wound will be changed.
• The CPM machine will be advanced to gain knee motion.
• If you have been unable to have a bowel movement (pain
medicine commonly causes constipation) and you are
uncomfortable, please tell your nurse.
• Physical therapy continues:
- Continue exercises.
- Your knee range of
motion will be measured
and charted.
- You should become independent with transfers. You will
require less assistance for transferring in and out of bed.
- If it is possible, you will practice ambulating with
crutches instead of a walker. Your goal should be to
walk independently with a walker, crutches, or cane as
soon as possible.
• If you will be discharged to a post-acute care facility, you will
probably be transferred by ambulance today. You will bring
a Lahey Clinic Knee Replacement Post-Acute Care Plan
with you to the rehabilitation facility.
8
• If you will be discharged to home, the Occupational
Therapist will assist you with the performance of everyday
activities such as bathing and dressing. They will show you
techniques to assist with these activities at home.
21
Postoperative Day #2
• The dressing on your wound will be changed.
• A blood test will be drawn to measure the effectiveness of the
blood thinner (Coumadin). This blood test will be drawn
intermittently as long as you take Coumadin.
• If you are constipated, you may request medications, a
suppository, or an enema.
• The CPM machine will be advanced to gain knee motion.
• Physical therapy continues:
- Continue exercises from post-operative day 1.
- Your exercises will be advanced by the physical
therapist. These exercises will focus on maximizing
range of motion of your knee – flexion (bending)
and extension (straightening).
- Your knee range of motion will be measured and charted.
- Muscle strengthening exercises will begin.
- Practice transfers. You should be getting into a chair at least
two times a day with assistance from the physical therapy or
nursing staff.
- You will begin walking with a walker or crutches.
20
• The case manager, in discussions with you, your family, your
physicians, your therapists, and your healthcare insurance
company will finalize discharge planning. Transfer to a
rehabilitation hospital will occur on postoperative day three.
Discharge to home will be on postoperative day four or five.
CASE MANAGER
Before your operation, you will be contacted by a Lahey Clinic
Case Manager who will help you plan your discharge from the
hospital to a rehabilitation facility or to home. Advance
planning helps alleviate concerns you and your family may have
about what will happen after you leave the hospital. Your health
insurance company will have input concerning where you may
go after hospital discharge. Speak to your health insurance
representative about your options.
ANESTHESIA
Most patients will meet their anesthesiologist on the day of
surgery. He or she will review your medical records and answer
questions you may have about anesthesia. If you have a preference
for a type of anesthesia, please tell your anesthesiologist. We
encourage you to follow your anesthesiologist’s recommendations.
If you have a specific condition which requires a pre-operative
consultation with an anesthesiologist, please let us know.
PERSONAL PREPARATIONS FOR
SURGERY
Prepare Yourself:
• Stop smoking. This will help your breathing, improve
wound healing, and reduce postoperative
complications. (At least cut back).
• Eat well-balanced meals. This is not the time for serious
weight loss.
• Start taking an over-the-counter iron supplement one
month prior to surgery (FeSO4 325 mg three times per
day).
9
• Get plenty of rest.
• Cut back or eliminate alcohol.
• Exercise to improve and maintain muscle tone and joint
motion.
• Develop a positive attitude for knee replacement.
Prepare Your Home:
• If possible, arrange a one floor living area with
kitchen/bed/bathroom to minimize stairs.
• Rearrange furniture to enlarge walking paths for
crutches or a walker.
• Remove scatter rugs.
• Make sure all doorknobs are clear and accessible.
• Install night lights.
• Obtain an apron with pockets or a backpack. Your
hands will be using crutches.
• Stock freezer and pantry.
• Obtain a cordless phone.
• Non-skid mats for shower/tub.
• Grab bars in the shower/tub, near toilet.
• Tub seat.
• Raised toilet seat or commode.
• Long handle sponge.
• Stocking aid.
• Long handle shoe horn.
• Long handle reacher.
Prepare For Hospital
Discharge:
• Discuss hospital and discharge plans with relatives and friends.
• Evaluate the options of home discharge or rehabilitation
facility discharge.
• Review insurance coverage as it pertains to discharge.
10
- You will begin the exercises which you learned
before your operation (Page 12).
1. Ankle pumps
2. Quadriceps sets/knee straightening
3. Gluteal sets
4. Lower leg lifts/short arc quadriceps sets
5. Straight leg raise
6. Heel slides
- The therapists will measure the range of motion of
your knee. They will note your progress on a wall
chart (use the chart on page 22). During the first
two weeks after your operation, your most
important job is to achieve functional range of
motion. Your goal is to maximize flexion (bending)
to 120˚ and extension (straightening) to 0˚.
- The therapists and the nurses will help you out of
bed and into a chair. Hopefully, you can do this two
or three times on postoperative day one. During
transfers (getting in and out of your bed or chair)
you can generally put as much weight on your
operated leg as you wish. Weight bearing may be
restricted for some patients.
• Safety precautions for patients with knee replacements
will be discussed.
• A case manager will
visit with you and
your family. Planning
for your discharge
from the hospital now
begins in earnest.
19
• You will receive an antibiotic to prevent infection.
• You will receive a blood thinner medication to prevent
blood clots.
• When you are ready, and when your room is ready, you
will be transferred from the recovery room to your
hospital room. Family members and friends may visit
you in your hospital room.
Prepare A Hospital Bag:
• Personal care items.
• Loose, comfortable clothing.
• Shorts, sweatpants, t-shirts.
• Low-heeled supportive shoes or sneakers with non-skid soles.
• “Walkman” type tape/CD/MP3 player if you like music.
• Cash for newspaper, snacks, etc.
• Credit card for TV/telephone/internet access.
• Some patients will spend their first night in the hospital
in the recovery room.
Postoperative Day #1
• Use your incentive spirometer to expand your lungs.
• Several blood tests will be drawn to monitor your recovery.
• Your diet will begin with clear liquids. It will be
advanced when it is safe to do so.
• A bowel regimen including stool softeners will be instituted
to prevent constipation.
• If you have a bladder catheter, it will probably be removed.
• The CPM machine will be advanced to gain motion.
• Physical therapy begins:
18
- The physical therapy exercises and the CPM will help the
knee to bend. When you are not bending the knee in the
CPM or with therapy, it is very important to keep the leg
straight. Do not put pillows or blankets under your
knee. It is best to put a rolled up towel or pillow under
your foot and ankle, to help straighten out your knee.
11
PHYSICAL THERAPY
AFTER SURGERY: DAY BY DAY
Successful knee replacement requires careful, compulsive
rehabilitation. Physical therapy is essential to the success of
knee replacement.
This schedule presents a sequence of events that usually follow
knee replacement operations at Lahey Clinic.
Physical therapy will begin the day after your operation. The
therapist will teach you to get in and out of bed, get in and out
of a chair, walk using a walker or crutches, and climb stairs.
You will be taught exercises to mobilize and stretch your knee.
After your operation, the therapist will work with you for a
brief period each day, and you will do your exercises on your
own several times a day. You must know how to do these
exercises on your own.
• When your knee replacement operation is finished, you
will be taken to the recovery room. You will be drowsy,
and you may not recall much about the operation or
recovery room experience. Your family will be able to see
you briefly in the recovery room.
We recommend that you practice the following exercises
before your surgery. You will perform similar exercises after
surgery. Perform each exercise 10-15 times.
Ankle Pumps:
Move your foot up and down slowly feeling a gentle stretch
in the calf muscle. This can be performed lying down in bed
or sitting in a chair. After operation, this exercise will help
prevent a blood clot.
Quadriceps Sets/Knee Straightening:
With your leg out straight, tighten your thigh muscle and
push the back of your knee down into the bed. Hold for 510 seconds. Relax. After operation, this exercise will help
gain knee extension.
12
Gluteal Sets:
Squeeze your buttocks muscles together and hold for 5-10
seconds. Relax. This exercise can also be done sitting in a
chair.
Day of Surgery
• When you arrive in the recovery room, you will have an
intravenous line for fluid replacement. Support
stockings or elastic bandages will be on your legs to
prevent blood clots.
• To control pain after surgery, you will be given
medication through an intravenous line or by injection.
The next day you will be given pills for pain.
• After surgery, some patients will have their operated leg
placed in a continuous passive motion (CPM) machine.
This machine will flex (bend) and extend (straighten)
your knee while you are in bed.
• The nurses will give you an incentive spirometer. You
will take long, deep breaths with this machine to fully
expand your lungs. It is important that you do this at
least 10 times every hour, when you are awake.
• You may discover that when you were anesthetized, a catheter
was passed into your bladder to monitor your urine output.
This will be removed on the first day after your surgery.
17
OPERATION AND HOSPITAL STAY
Please arrive on time on the day of your operation. You will
be admitted to the hospital, and you will dress in hospital
clothes. A name band will be placed on your wrist. All jewelry
must be removed. Your family will take your personal items.
You will see your surgeon and his/her assistants prior to your
operation. Your surgeon will mark your surgical site with a
marker.
Your nurse will record your temperature, blood pressure, pulse
rate and respiratory rate. You will be asked to empty your
bladder. An intravenous line will be started. Extra blood may be
drawn for testing or blood management.
Lower Leg Lifts/Short Arc Quadriceps Sets:
Place a rolled up towel (approximately 8 inches in diameter)
under your knee. Straighten out your knee by lifting up
your lower leg and foot. Hold for 3-5 seconds. Slowly lower
down placing heel on bed.
Straight Leg Raise:
Lie on your back. Bend your good leg. Keep your opposite
leg straight. Lift your straight leg up 8 inches, slowly lower
your leg.
Heel Slides:
Lie on your back. Slide your heel towards your buttocks (as
far as you can go). Slowly straighten your leg.
When the operating room is ready, and the operating team is
assembled, you will be escorted into the operating room on a
stretcher. In the operating room, you will be transferred onto
the operating table, where anesthesia will be induced. At this
point, your knee replacement operation is ready to begin.
Family members who wish to wait at Lahey during your
surgery may do so in the Family Waiting Room. Your surgeon
will speak with them after your surgery. Otherwise, your
surgeon will call a family member or friend after surgery.
16
13
FINAL PRE-OPERATIVE VISIT:
DAY BEFORE SURGERY
You will have a pre-operative visit with a physician assistant or nurse
practitioner who will perform a history and physical, check your
tests, review your consultations, and answer questions. You will be
asked to sign an Informed Consent document regarding your
operation.
On the day before your knee replacement, you can eat or
drink anything you wish up until midnight. After midnight
you must not eat or drink anything unless directed
otherwise by your doctor. You will be asked to take one
anticoagulation pill (Coumadin) on the night before your
surgery. You may have small quantities of water up until two
hours prior to your scheduled time of arrival to the hospital.
A week before surgery please stop taking all anti-inflammatory drugs.
If you are uncertain if your arthritis pain medication is an antiinflammatory drug, please ask your doctor.
It is possible to take acetaminophen or Tylenol for pain up until the
night before surgery.
On the day before surgery, you will be called and told what
time to report to Lahey Clinic for your operation.
Please leave all jewelry and valuables at home. Your family and
friends can bring personal items to you after your operation.
Please stop taking fish oil, vitamin E, or ginkgo two weeks before
surgery as these supplements can affect bleeding.
If you take an immune
system modifying drug such
as Methotrexate, Enbrel,
Remicaide, or Humira,
please discuss this with your
medical doctor and your
surgeon. You will need to
discontinue this drug in the
peri-operative period.
If you take anticoagulation medicine please ask your surgeon if and
when to discontinue this drug before your knee replacement.
If you get a cold, or the flu in the week or two before your surgery,
please notify your surgeon.
14
15
FINAL PRE-OPERATIVE VISIT:
DAY BEFORE SURGERY
You will have a pre-operative visit with a physician assistant or nurse
practitioner who will perform a history and physical, check your
tests, review your consultations, and answer questions. You will be
asked to sign an Informed Consent document regarding your
operation.
On the day before your knee replacement, you can eat or
drink anything you wish up until midnight. After midnight
you must not eat or drink anything unless directed
otherwise by your doctor. You will be asked to take one
anticoagulation pill (Coumadin) on the night before your
surgery. You may have small quantities of water up until two
hours prior to your scheduled time of arrival to the hospital.
A week before surgery please stop taking all anti-inflammatory drugs.
If you are uncertain if your arthritis pain medication is an antiinflammatory drug, please ask your doctor.
It is possible to take acetaminophen or Tylenol for pain up until the
night before surgery.
On the day before surgery, you will be called and told what
time to report to Lahey Clinic for your operation.
Please leave all jewelry and valuables at home. Your family and
friends can bring personal items to you after your operation.
Please stop taking fish oil, vitamin E, or ginkgo two weeks before
surgery as these supplements can affect bleeding.
If you take an immune
system modifying drug such
as Methotrexate, Enbrel,
Remicaide, or Humira,
please discuss this with your
medical doctor and your
surgeon. You will need to
discontinue this drug in the
peri-operative period.
If you take anticoagulation medicine please ask your surgeon if and
when to discontinue this drug before your knee replacement.
If you get a cold, or the flu in the week or two before your surgery,
please notify your surgeon.
14
15
OPERATION AND HOSPITAL STAY
Please arrive on time on the day of your operation. You will
be admitted to the hospital, and you will dress in hospital
clothes. A name band will be placed on your wrist. All jewelry
must be removed. Your family will take your personal items.
You will see your surgeon and his/her assistants prior to your
operation. Your surgeon will mark your surgical site with a
marker.
Your nurse will record your temperature, blood pressure, pulse
rate and respiratory rate. You will be asked to empty your
bladder. An intravenous line will be started. Extra blood may be
drawn for testing or blood management.
Lower Leg Lifts/Short Arc Quadriceps Sets:
Place a rolled up towel (approximately 8 inches in diameter)
under your knee. Straighten out your knee by lifting up
your lower leg and foot. Hold for 3-5 seconds. Slowly lower
down placing heel on bed.
Straight Leg Raise:
Lie on your back. Bend your good leg. Keep your opposite
leg straight. Lift your straight leg up 8 inches, slowly lower
your leg.
Heel Slides:
Lie on your back. Slide your heel towards your buttocks (as
far as you can go). Slowly straighten your leg.
When the operating room is ready, and the operating team is
assembled, you will be escorted into the operating room on a
stretcher. In the operating room, you will be transferred onto
the operating table, where anesthesia will be induced. At this
point, your knee replacement operation is ready to begin.
Family members who wish to wait at Lahey during your
surgery may do so in the Family Waiting Room. Your surgeon
will speak with them after your surgery. Otherwise, your
surgeon will call a family member or friend after surgery.
16
13
PHYSICAL THERAPY
AFTER SURGERY: DAY BY DAY
Successful knee replacement requires careful, compulsive
rehabilitation. Physical therapy is essential to the success of
knee replacement.
This schedule presents a sequence of events that usually follow
knee replacement operations at Lahey Clinic.
Physical therapy will begin the day after your operation. The
therapist will teach you to get in and out of bed, get in and out
of a chair, walk using a walker or crutches, and climb stairs.
You will be taught exercises to mobilize and stretch your knee.
After your operation, the therapist will work with you for a
brief period each day, and you will do your exercises on your
own several times a day. You must know how to do these
exercises on your own.
• When your knee replacement operation is finished, you
will be taken to the recovery room. You will be drowsy,
and you may not recall much about the operation or
recovery room experience. Your family will be able to see
you briefly in the recovery room.
We recommend that you practice the following exercises
before your surgery. You will perform similar exercises after
surgery. Perform each exercise 10-15 times.
Ankle Pumps:
Move your foot up and down slowly feeling a gentle stretch
in the calf muscle. This can be performed lying down in bed
or sitting in a chair. After operation, this exercise will help
prevent a blood clot.
Quadriceps Sets/Knee Straightening:
With your leg out straight, tighten your thigh muscle and
push the back of your knee down into the bed. Hold for 510 seconds. Relax. After operation, this exercise will help
gain knee extension.
12
Gluteal Sets:
Squeeze your buttocks muscles together and hold for 5-10
seconds. Relax. This exercise can also be done sitting in a
chair.
Day of Surgery
• When you arrive in the recovery room, you will have an
intravenous line for fluid replacement. Support
stockings or elastic bandages will be on your legs to
prevent blood clots.
• To control pain after surgery, you will be given
medication through an intravenous line or by injection.
The next day you will be given pills for pain.
• After surgery, some patients will have their operated leg
placed in a continuous passive motion (CPM) machine.
This machine will flex (bend) and extend (straighten)
your knee while you are in bed.
• The nurses will give you an incentive spirometer. You
will take long, deep breaths with this machine to fully
expand your lungs. It is important that you do this at
least 10 times every hour, when you are awake.
• You may discover that when you were anesthetized, a catheter
was passed into your bladder to monitor your urine output.
This will be removed on the first day after your surgery.
17
• You will receive an antibiotic to prevent infection.
• You will receive a blood thinner medication to prevent
blood clots.
• When you are ready, and when your room is ready, you
will be transferred from the recovery room to your
hospital room. Family members and friends may visit
you in your hospital room.
Prepare A Hospital Bag:
• Personal care items.
• Loose, comfortable clothing.
• Shorts, sweatpants, t-shirts.
• Low-heeled supportive shoes or sneakers with non-skid soles.
• “Walkman” type tape/CD/MP3 player if you like music.
• Cash for newspaper, snacks, etc.
• Credit card for TV/telephone/internet access.
• Some patients will spend their first night in the hospital
in the recovery room.
Postoperative Day #1
• Use your incentive spirometer to expand your lungs.
• Several blood tests will be drawn to monitor your recovery.
• Your diet will begin with clear liquids. It will be
advanced when it is safe to do so.
• A bowel regimen including stool softeners will be instituted
to prevent constipation.
• If you have a bladder catheter, it will probably be removed.
• The CPM machine will be advanced to gain motion.
• Physical therapy begins:
18
- The physical therapy exercises and the CPM will help the
knee to bend. When you are not bending the knee in the
CPM or with therapy, it is very important to keep the leg
straight. Do not put pillows or blankets under your
knee. It is best to put a rolled up towel or pillow under
your foot and ankle, to help straighten out your knee.
11
• Get plenty of rest.
• Cut back or eliminate alcohol.
• Exercise to improve and maintain muscle tone and joint
motion.
• Develop a positive attitude for knee replacement.
Prepare Your Home:
• If possible, arrange a one floor living area with
kitchen/bed/bathroom to minimize stairs.
• Rearrange furniture to enlarge walking paths for
crutches or a walker.
• Remove scatter rugs.
• Make sure all doorknobs are clear and accessible.
• Install night lights.
• Obtain an apron with pockets or a backpack. Your
hands will be using crutches.
• Stock freezer and pantry.
• Obtain a cordless phone.
• Non-skid mats for shower/tub.
• Grab bars in the shower/tub, near toilet.
• Tub seat.
• Raised toilet seat or commode.
• Long handle sponge.
• Stocking aid.
• Long handle shoe horn.
• Long handle reacher.
Prepare For Hospital
Discharge:
• Discuss hospital and discharge plans with relatives and friends.
• Evaluate the options of home discharge or rehabilitation
facility discharge.
• Review insurance coverage as it pertains to discharge.
10
- You will begin the exercises which you learned
before your operation (Page 12).
1. Ankle pumps
2. Quadriceps sets/knee straightening
3. Gluteal sets
4. Lower leg lifts/short arc quadriceps sets
5. Straight leg raise
6. Heel slides
- The therapists will measure the range of motion of
your knee. They will note your progress on a wall
chart (use the chart on page 22). During the first
two weeks after your operation, your most
important job is to achieve functional range of
motion. Your goal is to maximize flexion (bending)
to 120˚ and extension (straightening) to 0˚.
- The therapists and the nurses will help you out of
bed and into a chair. Hopefully, you can do this two
or three times on postoperative day one. During
transfers (getting in and out of your bed or chair)
you can generally put as much weight on your
operated leg as you wish. Weight bearing may be
restricted for some patients.
• Safety precautions for patients with knee replacements
will be discussed.
• A case manager will
visit with you and
your family. Planning
for your discharge
from the hospital now
begins in earnest.
19
Postoperative Day #2
• The dressing on your wound will be changed.
• A blood test will be drawn to measure the effectiveness of the
blood thinner (Coumadin). This blood test will be drawn
intermittently as long as you take Coumadin.
• If you are constipated, you may request medications, a
suppository, or an enema.
• The CPM machine will be advanced to gain knee motion.
• Physical therapy continues:
- Continue exercises from post-operative day 1.
- Your exercises will be advanced by the physical
therapist. These exercises will focus on maximizing
range of motion of your knee – flexion (bending)
and extension (straightening).
- Your knee range of motion will be measured and charted.
- Muscle strengthening exercises will begin.
- Practice transfers. You should be getting into a chair at least
two times a day with assistance from the physical therapy or
nursing staff.
- You will begin walking with a walker or crutches.
20
• The case manager, in discussions with you, your family, your
physicians, your therapists, and your healthcare insurance
company will finalize discharge planning. Transfer to a
rehabilitation hospital will occur on postoperative day three.
Discharge to home will be on postoperative day four or five.
CASE MANAGER
Before your operation, you will be contacted by a Lahey Clinic
Case Manager who will help you plan your discharge from the
hospital to a rehabilitation facility or to home. Advance
planning helps alleviate concerns you and your family may have
about what will happen after you leave the hospital. Your health
insurance company will have input concerning where you may
go after hospital discharge. Speak to your health insurance
representative about your options.
ANESTHESIA
Most patients will meet their anesthesiologist on the day of
surgery. He or she will review your medical records and answer
questions you may have about anesthesia. If you have a preference
for a type of anesthesia, please tell your anesthesiologist. We
encourage you to follow your anesthesiologist’s recommendations.
If you have a specific condition which requires a pre-operative
consultation with an anesthesiologist, please let us know.
PERSONAL PREPARATIONS FOR
SURGERY
Prepare Yourself:
• Stop smoking. This will help your breathing, improve
wound healing, and reduce postoperative
complications. (At least cut back).
• Eat well-balanced meals. This is not the time for serious
weight loss.
• Start taking an over-the-counter iron supplement one
month prior to surgery (FeSO4 325 mg three times per
day).
9
BLOOD MANAGEMENT
Most patients who have one knee replacement will not
require blood transfusion. A tourniquet is placed on your
thigh to prevent blood loss during the operation. However,
you will lose blood into your knee and leg after the operation
when the tourniquet is removed.
Some patients will require a blood transfusion after knee
replacement. Factors associated with a need to transfuse blood
include; a low hemoglobin or hematocrit (“low blood count”)
before operation, cardiac conditions, medical disease,
extensive knee reconstruction, unexpected post-operative
blood loss, and bilateral knee replacements on the same day.
In some cases, your surgeon may ask you to donate your own
blood for possible transfusion – autologous transfusion. This
blood is refrigerated and stored until the time of your
operation. If transfusion is necessary, you will be transfused
with your own blood. In some cases, on the day of your
surgery, your anesthesiologist may draw off some of your
blood before the operation in order to give it back to you after
surgery – hemodilution. In some cases it may be necessary for
you to be transfused with Blood Bank blood.
Postoperative Day #3
• The dressing on your wound will be changed.
• The CPM machine will be advanced to gain knee motion.
• If you have been unable to have a bowel movement (pain
medicine commonly causes constipation) and you are
uncomfortable, please tell your nurse.
• Physical therapy continues:
- Continue exercises.
- Your knee range of
motion will be measured
and charted.
- You should become independent with transfers. You will
require less assistance for transferring in and out of bed.
- If it is possible, you will practice ambulating with
crutches instead of a walker. Your goal should be to
walk independently with a walker, crutches, or cane as
soon as possible.
• If you will be discharged to a post-acute care facility, you will
probably be transferred by ambulance today. You will bring
a Lahey Clinic Knee Replacement Post-Acute Care Plan
with you to the rehabilitation facility.
8
• If you will be discharged to home, the Occupational
Therapist will assist you with the performance of everyday
activities such as bathing and dressing. They will show you
techniques to assist with these activities at home.
21
Postoperative Day #4
ACADEMIC MEDICAL CENTER
- Your knee range of motion will be measured and
charted.
Lahey Clinic is an academic medical center. Lahey Clinic doctors
teach residents, students and post graduate fellows how to be
doctors and surgeons. Boston University orthopaedic surgery
residents train at Lahey Clinic. You will meet the students,
residents and fellows as members of the orthopaedic team.
Orthopaedic residents and fellows will participate in your
operation to help your surgeon and learn about knee replacement.
Students and visiting doctors may observe your operation. Your
orthopaedic surgeon will do your knee replacement operation.
- Continue all motion and strengthening exercises
PHYSICAL EXAMINATION/TESTS
- Practice independent transfers.
Generally, a physical examination by an internal medicine doctor
is recommended to ensure that you are healthy enough to
undergo major surgery. If you are new to Lahey Clinic, or if you
have a primary care physician outside Lahey, please bring a letter
from your doctor to your pre-operative visit which describes your
past medical history and your current medical condition.
Consultation with other medical specialists may also be necessary.
Several diagnostic tests, including chest x-ray, EKG, and blood
and urine tests may be scheduled. You need to bring a list of all
your current medications, including prescription drugs, over the
counter medicines, vitamins, herbs, and nutritional supplements
when you come for your preoperative visit. An up-to-date medical
history which includes current and past health problems, allergies,
hospitalizations, and surgeries will be recorded. If you have dental
problems, please inform us and
seek appropriate care well before
your surgery date. Dental
infection can lead to knee
infection.
• The dressing on your wound will be changed. If your
wound is dry, it may not be necessary to cover it.
• The CPM machine will be advanced to gain motion.
• Physical therapy continues:
- Practice independent ambulation with
crutches/walker.
- Practice stair climbing.
- Review knee safety precautions.
Lahey Clinic
Physical Therapy Department
ROM DATA GRAPH
Degrees
120
110
100
90
80
70
60
50
40
30
20
10
0
1
2
3
4
5
Post-operative Day
22
flexion (bending)
extension (straighten leg)
6
7
8
9
10
11
12
13 14
your own
motion!
ChartChart
your
own
motion!
7
GETTING READY FOR SURGERY
LEAVING THE HOSPITAL
Once you have decided to have your knee replaced, there is
much to do to prepare for your operation. Lahey Clinic
provides a team approach to your care. You will have a
chance to meet members of the team before surgery. They
will answer your questions and make arrangements to insure
that your surgery, hospital stay, and post-operative recovery
will go as smoothly as possible.
To a Rehabilitation Facility
SCHEDULING YOUR OPERATION
Surgical scheduling is a complex process. Your operation
requires you, your surgeon, an anesthesiologist, surgical
assistants, nurses, an operating room, surgical instruments,
knee implants, and many pieces of equipment to be in the
same place at the same time. You will work with a surgical
scheduler to select an acceptable date for your knee
replacement operation. Please be as flexible as possible in
working with your surgical scheduler.
INFORMED CONSENT
If you choose to go to a rehabilitation facility, and if your health
plan approves this choice, you will be discharged on the second
or third day after surgery. Your case manager will assist you and
your family with discharge plans. You will bring a Lahey Clinic
Knee Replacement Post Acute Care Plan with you to the
rehabilitation facility. Follow-up with your surgeon will also be
arranged.
To Home
If you are medically stable, independent with walker/crutches/
cane, and knowledgeable in knee replacement precautions, and
if you have help available at home, you may choose to be
discharged to home. Your case manager will assist you and your
family with discharge plans. Physical Therapy at a therapists
office or at home will be arranged. You will take pain
medication and blood thinners at home. Usually, you will
resume your routine medications at home – review these
medications with your primary care physician.
You will be asked to sign an informed consent document which
gives Lahey Clinic and the Lahey Clinic professional staff
permission to give you a knee replacement operation. This
booklet will teach you about knee replacement so you will be a
well informed patient. You will also be asked to give Lahey Clinic
permission to collect information about your knee replacement in
the Lahey Clinic total joint database.
6
23
IMPORTANT INFORMATION AS
YOU LEAVE LAHEY CLINIC
INNOVATION, TECHNOLOGY, AND
INFORMATION
Follow-Up Visits
Total knee arthroplasty uses anatomically designed implants made
of high grade biomaterials to resurface arthritic knee joints. As new
materials, designs, and techniques are developed to improve knee
replacement, Lahey knee surgeons evaluate new technology for
possible use with Lahey patients. Lahey Clinic orthopaedic
surgeons use the best techniques and best implants available to
provide predictably successful knee replacement operations.
Two Weeks:
Usually, your surgeon or his assistant will see you in the outpatient
clinic to remove skin staples or sutures two weeks after surgery. If
you go to a rehabilitation hospital, they may remove your staples
or sutures.
Four to Six Weeks:
Usually, you will see your surgeon four to six weeks following
surgery for a clinical and radiographic examination.
Knee Range of Motion
It is your responsibility to achieve a full, functional range of
motion from 120˚ flexion (bend) to 0˚ extension (straight). Your
surgeon, your therapist, CPM machines, and your family will
help, but ultimately, each knee replacement patient must
achieve knee motion by him/herself.
Please do not put pillows under your knee in slight flexion to be
comfortable. This will slow your therapy. When resting put your
knee in a maximum flexion or maximum extension position.
Wound Care
24
Keep your incision dry while staples are in. You should keep a
dressing on your wound if there is drainage. If the wound is clean
and dry, you can leave it open to air. Look at your wound each
day. If you notice signs of possible infection such as: increasing
redness, increasing warmth, or new drainage that looks like pus,
call your surgeon immediately. If your doctor or nurse want to
give you an antibiotic for your knee, please ask him/her to call
your surgeon first.
Innovations that may be appropriate for some patients include:
• modular knee replacement
• all polyethylene tibial implant
• mobile bearing knee replacement
• bilateral knee replacement
• minimally invasive knee replacement
• computer assisted surgical navigation
Information on total knee arthroplasty is
available from many sources including the internet and direct-toconsumer marketing programs. Some of this information is accurate
and useful. Some of this information is not accurate. Information
on clinical services, educational programs, and orthopaedic
research in the Lahey Clinic Department of Orthopaedic
Surgery is available at www. lahey.org/OrthopaedicSurgery.
The Lahey Clinic hospital is a “high reliability organization”
committed to patient safety and prudent use of new “cutting edge”
technology in caring for our patients.
All Lahey Clinic hospital rooms are private rooms equipped with
flat screen personal computers which provide knee replacement
patients with access to television, radio, games, music, email, and
the internet.
5
TYPES OF KNEE REPLACEMENTS
Toileting
Total Knee Arthroplasty (TKA)
Most home toilet seats are low. A commode or raised toilet
seat will be helpful. Toilet grab bars may also be helpful.
Total Knee Arthroplasty or Total Knee Replacement is the
operation described in this booklet. TKA can be a fixed bearing
knee replacement or a mobile bearing knee replacement. The
goal of TKA is to relieve pain and improve function. TKA is the
most common type of knee replacement.
Unicompartmental Knee Replacement (UKA)
Unicompartmental Knee Arthroplasty or Unicompartmental
Knee Replacement resurfaces part of the knee joint. This
operation may also be called a partial knee replacement.
Either the medial (inside) or the lateral (outside) tibiofemoral joint is resurfaced. This operation is less common
than total knee replacement.
Minimally Invasive Knee Replacement
(Minimal Incision/Less Invasive) A Minimally Invasive Knee
Replacement operation (TKA or UKA) is performed through
a small incision with less tissue dissection. Some patients are
not candidates for minimally invasive knee replacement.
Revision Total Knee Arthroplasty
Revision total knee arthroplasty is an operation which revises
or fixes a knee replacement which has developed a problem
such as loosening of fixation, wear of bearing surfaces,
fracture, or instability.
Bilateral Total Knee Arthroplasty
Some patients with two equally symptomatic arthritic knees
may be candidates for Bilateral TKA on the same day.
4
Bathing
While your skin staples or sutures are in your knee incision,
please use sponge baths for personal hygiene. Please do not get
your knee replacement wound wet. You may shower or bathe
after your skin staples or sutures are removed. Bathing is
best done in the shower – getting in and out of a tub can be
difficult and dangerous when recovering from knee surgery.
Grab bars in the shower/tub area may be helpful. A longhandled sponge, can be helpful for bathing your lower body.
Some patients find a tub seat in the shower to be helpful. Be
cautious when walking on slippery bathroom floors.
Dressing
Some patients will need assistive devices in order to dress
independently. A stocking aid may enable you to put on your
socks without bending over too far. A long-handled shoehorn
will assist you in putting on your shoes. Long-handled
reachers may assist you in putting on and pulling up your
pants. You will be evaluated during your hospital stay for your
particular needs at home.
Compressive Stockings
The white TED stockings should be worn on both legs when
you are up during the day. They help control swelling in your
legs (especially in your operated leg). At night, you can remove
them and launder them, if necessary. Usually, you will be asked
to wear these stockings for four to six weeks after surgery.
25
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3
CHOOSING
KNEE
REPLACEMENT
Knee replacement is an elective surgical procedure. This
operation is one of several non-surgical and surgical options which
are available for treatment of your arthritic knee. It is important
for you to be familiar with all possible treatments for your knee.
Non-operative treatment options for an arthritic knee include:
anti-inflammatory medicine, pain medication, physical therapy,
weight loss, walking aids such as a cane or crutches, nutritional
supplements, injections, and restricting your activities. Many
patients with arthritic knees try non-surgical treatment before
choosing surgical treatment.
Surgical treatments for an arthritic knee include: arthroscopy,
osteotomy, fusion, partial knee replacement, and total knee
replacement. Each operation has specific indications, and all
surgical treatments are not appropriate for all patients.
Generally, knee replacement is very successful. Knee pain is
relieved, deformity is corrected, and function improves. It is not
clear how long a knee replacement will last. The long-term success
rate will vary, depending on your age, your weight, and your
activity. “Plan on ten to fifteen years and hope for twenty”. If a knee
replacement becomes loose or wears out, generally it can be fixed
with a revision knee replacement operation.
2
Knee replacement is major surgery. When choosing to have a
knee replacement, it is important to be aware of potential risks
and complications such as: problems from anesthesia, bleeding,
damage to nerves or blood vessels, instability, dislocation,
fracture, ligament injury, blood clot, infection, and very
rarely, death.
GUIDELINES AFTER KNEE
REPLACEMENT
For your safety, and to ensure a successful outcome following
your knee replacement operation, you should adhere to the
following guidelines.
FOR THE FIRST TWO MONTHS
• Push to gain maximum
range of motion during
the first four weeks
following surgery. Knee
motion is critical to the
success of this operation.
• During the day time get
up every half-hour or so
and take a brief walk.
Prolonged sitting may
allow muscles around
your knee to get stiff.
• Avoid slippery surfaces
which may allow your leg to give way.
• When sleeping, do not place a pillow under your knee.
This will prevent you from gaining full extension
(straightening) of your knee. Try to sleep on your back
with a towel roll under your ankle.
• When your surgeon prescribes strengthening
exercises, work hard to make your hip and knee
muscles strong.
27
A Patient’s Guide to Knee Replacement
• Stay active and bear weight on your reconstructed knee.
• Airline travel within the first 2 months after knee
replacement operation increases the risk of developing a
blood clot. Please discuss this with your surgeon.
Walking is an essential part of physical therapy. You
should take daily walks, lengthening your walking distances as
your strength improves.
FOR THE REST OF YOUR LIFE
Your knee replacement should provide mobility, stability,
and pain free function for many years. You can participate in
many activities with your “new knee”. However, you should
protect your knee replacement from excess stress which can lead
to premature failure of the artificial joint. Avoid weight gain
which will increase stress on your new knee. High impact
loading activities such as jumping, running, jogging, and heavy
weight lifting should be avoided. Sports, such as basketball,
racquetball, squash, volleyball, and tennis, increase the risk of
implant loosening and implant wear. You may choose to
participate in these sports, but you must accept the associated
risk. Low-impact loading activities such as walking, boating,
cycling, swimming, bowling, and golf are excellent activities for
recreation and exercise after knee replacement.

CONTENTS
Choosing Knee Replacement ..............................................2
What is a Knee Replacement? ............................................3
Types of Knee Replacements ..............................................4
Innovation, Technology, and Information ..........................5
Getting Ready for Surgery ..................................................6
Scheduling Your Operation ................................................6
Informed Consent ..............................................................7
Academic Medical Center ..................................................7
Physical Examination/Tests ................................................7
Blood Management ............................................................8
Case Manager......................................................................9
Anesthesia ..........................................................................9
Personal Preparations For Surgery ......................................9
Physical Therapy ..............................................................12
Final Pre-operative Visit ....................................................14
Day Before Surgery ..........................................................15
Operation and Hospital Stay ............................................16
After Surgery: Day by Day ................................................17
Leaving the Hospital ........................................................23
To Rehabilitation Facility ..............................23
To Home ......................................................23
Important Information As You Leave Lahey Clinic ..........24
Follow-up Visits ............................................24
Knee Range of Motion ..................................24
Wound Care ..................................................24
Toileting ........................................................25
Bathing..........................................................25
Dressing ........................................................25
Compressive Stockings ..................................25
Driving ..........................................................26
Sexual Relations ............................................26
Dental Work..................................................26
Infections ......................................................26
Guidelines After Knee Replacement ..................................27
For the First Two Months ..............................27
For the Rest of Your Life................................28

A Patient’s Guide to Knee Replacement
Dear Knee Replacement Patient,
We hope this Patient Guide to Knee Replacement provides valuable information as you
prepare for your knee replacement operation. More information about the Lahey Clinic
Department of Orthopaedic Surgery is available at www.lahey.org/OrthopaedicSurgery.
Enjoy your new knee!
Lahey Clinic Knee Replacement Surgeons
(Left to right)
Brian J. Jolley, M.D., Stephen E. Lemos, M.D., Richard Iorio, M.D.,
John F. Tilzey, M.D., William L. Healy, M.D., Richard M. Wilk, M.D.,
Michael S. Thompson, M.D., Lawrence M. Specht, M.D., Mark J. Lemos, M.D.,
Bernard A. Pfeifer, M.D.
If you have any questions or concerns about your knee replacement operation,
please call your Orthopaedic surgeon at Lahey Clinic, (781) 744-8650.
Lahey Clinic Department of Orthopaedic Surgery
A Patient’s Guide to
Department of Orthopaedic Surgery
41 Mall Road • Burlington, Massachusetts 01805
(781) 744-8650
See The Department of Orthopaedic Surgery at www.lahey.org
KNEE
REPLACEMENT