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    Knee Replacement Surgery: Part 1

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    See also Knee Replacement Surgery Part 2 which include, Pre-Registration For Surgery, Preparing For Surgery, Preparing For The Hospital, Follow-Up Care, To-Do Checklist, and Lodging and Transportation.

    What Is Total Knee Replacement

    A total knee replacement is a surgical procedure in which one's knee joint is removed and replaced with an artificial joint. Depending on your particular needs, the artificial joint, called a prosthesis, will be made of various materials including metal and plastic.

    During knee replacement surgery, your surgeon will make an incision (cut) on the front of your knee. The end of your femur (thigh bone) is trimmed and resurfaced with a metal cover or shell. The end of the tibia (lower leg bone) is trimmed and resurfaced with a plastic and metal implant.

    The surgery takes about two hours, but a successful knee replace-ment begins long before you enter the hospital.
    Knee before surgery and knee after replacement surgery
    Knee joint before (left) and after (right) knee replacement surgery.

    Normal knee showing Femur and Tibia and Prosthesis knee showing Metal cover and Plastic Piece

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    Your Team at CPMC

    Our nurses will be with you from the moment you arrive through surgery and until you are discharged. They work with your surgeon to make sure you are safe and on the right track toward recovery, while making sure your pain is under good control.

    R.N. Case Manager

    Your nurse case manager helps you make arrangements for going home, such as:

    • Home therapy
    • Discharge prescriptions
    • Medical equipment
    • Extra help at home

    Physical Therapist

    A physical therapist will visit you one or two times a day to teach you how to safely:

    • Get in and out of bed
    • Transfer in and out of a chair
    • Walk with the appropriate assistive device (front-wheeled walker or crutches) on flat surfaces, stairs and curbs
    • Get in and out of car safely

    Occupational Therapist

    An occupational therapist will see you once a day during your hospital stay to teach you how to safely perform your activities of daily living:
    • To sit down on/get up from the toilet
    • Get in and out of a bathtub or shower stall
    • Use adaptive equipment during hygiene care, dressing and bathing
    • Simple activities at the sink or kitchen counter

    Visiting Nursing and/or Physical/Occupational Therapy

    You may need nursing and/or physical/occupational therapy on a short-term basis at home. The focus of home health care is to help you adjust to the physical changes following surgery. They will help you find out which services are covered under your insurance plan.

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    Managing Your Pain

    Although there may be some discomfort after your surgery, keeping your pain under control speeds your recovery. Less pain will make it easier to concentrate on getting around safely on your new knee. When you are comfortable, you are better able to walk, breathe deeply and cough.

    FACES Pain Rating Scale. Choose a number between 0 to 10 that best describes your pain. 0=No Pain (Smiling). 2=Mild (Slightly Smiling). 4=Moderate (Expressionless). 6=Severe (Slightly Frowning). 8=Very Severe (Frowning). 10=Excruciating (Crying).

    You can help your doctors and nurses "rate" your pain using the pain scale. 0 means no pain and a 10 on the scale means the worst pain you can imagine.

    Pain Tips

    • Do not wait until the pain is severe (very bad).
    • Tell your nurses and doctors if you have pain.
    • If your pain suddenly gets worse or you experience chest pain or have trouble breathing, tell your nurses immediately.

    We Manage Pain In Many Ways

    We use several ways to help control your pain so you can focus on your physical and occupational therapy exercises

    • We may give you medications before surgery to help minimize the pain you would otherwise experience after surgery.
    • We use different types of pain medications (“multimodal analgesia”) that work well together to control pain.
    • Since pain medication can make some people feel nauseated, we also give you medications to prevent and control nausea.
    • Ice and repositioning are also effective ways to control pain.

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    Knee Strengthening Exercises

    You will recover from surgery faster if you begin strengthening your leg muscles before surgery with these special exercises.

    Do 10 repetitions of each exercise below, two times a day, unless your doctor tells you otherwise.

    ankle pump exercise
    Ankle Pumps
    Bend ankles to move feet up and down, alternating feet.

    quad sets exercise
    Quad Sets
    Slowly tighten muscles on thigh of straight leg while counting out loud to 10. Repeat with other leg to complete the set.

    gluteal squeezes exercise
    Gluteal Squeezes
    Squeeze buttocks muscles as tightly as possible while counting out loud to 10.

    heel slides exercise
    Heel Slides
    Make sure bed is flat. Bend knee and pull heel towards buttocks. Hold for 10 seconds. Return. Repeat with other knee to complete set.

    short arc quads exercise
    Short Arc Quads
    Place a rolled towel under your knee. Raise the lower part of your leg until your knee is straight. Hold for 10 seconds.

    straight leg raises exercise
    Straight Leg Raises
    Bend one leg. Keep the other leg as straight as possible and tighten muscles on top of the thigh. Slowly lift straight leg 10 inches from the bed and hold for 10 seconds. Lower it, keeping the muscle tight for 10 seconds. Relax.

    hip abduction exercise
    Hip Abduction
    Keep your toes pointed toward the ceiling. Move your leg out to the side as far as possible. Slowly return to the starting position and relax.

    long arc quads
    Long Arc Quads
    Straighten operative leg and try and hold it for 10 seconds.

    knee slides exercise
    Knee Slides
    Slowly slide your foot forward in front of you until a stretch is felt in the knee and hold for 10 seconds. Then slide your foot back as far as you can and hold for 10 seconds.position and relax.

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    Physical And Occupational Therapy Goals

    The focus of our rehabilitation program is to make you as indepen-dent as possible in your daily life activities. Therefore we will focus on the following goals during your physical and occupational therapy.

    1. Get out of bed
    2. Walk 50 feet with a walker or crutches
    3. Climb up and down stairs safely
    4. Get in and out of the car
    5. Dress
    6. Use the toilet
    7. Stand at the counter for 10 minutes
    8. Get in/out of the bathtub or shower stall

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