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    Knee Replacement Surgery: Part 2

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    See also Knee Replacement Surgery Part 1 which include, What Is Total Knee Replacement, Your Team at CPMC, Managing Your Pain, Knee Strenghtening Exercises, and Physical and Occupational Therapy Goals.

    Pre-Registration For Surgery

    By Phone
    Please call Sutter Health's Patient Registration Line at 1-855-398-1637 1-2 weeks before your surgery to preregister. The Patient Registration Line is open Monday – Friday, 8 a.m. to 5 p.m. Have your insurance information ready when you call. A nurse will take your health history, answer your questions and explain what tests are necessary before your surgery. The nurse may ask you to complete required testing before you come to the hospital.

    Medications
    Once your surgery is scheduled, CPMC will send you an information packet (Surgery, Tests and Procedures – A Pre-Registration Guide). Complete the Medication Form included in this packet and bring it with you on the day of surgery.

    Note:
    If you have diabetes or are taking blood-thinning medicines, please tell your doctor. Before you are discharged from the hospital, your doctor will write a prescription for any medication you will need at home, including blood thinners and pain medication.

    Blood Transfusions
    Blood loss from surgery sometimes leads to the need for a blood transfusion. If you have any personal concerns about blood transfusions, speak with your doctor before surgery. Other choices may be available.

    Anesthesia
    Before surgery, the anesthesiologist works with you and your surgeon to choose an anesthetic. For joint replacement surgery, this is often a spinal block, also known as spinal anesthesia. A spinal block produces a rapid numbing effect from your waist down. It is given in combination with sedatives to relax you and put you in a light sleep. In some situations, your doctors may use general anesthesia.
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    Preparing For Surgery

    Prepare Your Home
    Housekeeping and Food

    • Move furniture and clutter to make a clear path to your kitchen, bathroom and bedroom. The path should be wide enough for a walker.
    • Remove any loose rugs or other items you may trip over.
    • Buy groceries to prepare and freeze meals, and put cooking utensils within easy reach. Make simple meals that will be ready for you when you get home.
    • Place items you need every day at arm level to avoid bending over or reaching too far overhead.


    Bathroom

    • Place a nonskid bath mat in your tub or shower.
    • Purchase a raised toilet seat so that you can safely use your toilet. These items can be purchased at your local pharmacy or online.


    Furniture

    • You will need a stable, high back chair with armrests. You should not sit on a chair that rocks, rolls or swivels during your recovery from surgery.

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    Determine Who Is Going To Help You

    Getting Around
    Individuals who undergo joint replacement surgery typically are discharged from the hospital at 11 a.m. Arrange for someone to drive you home from the hospital and stay with you at home that day and possibly longer. You will not be allowed to take public transit or a taxi home alone. You will also need someone to drive you to appointments for several weeks.

    Help at Home
    You will need help with groceries, meal preparation and housekeeping for several weeks. Either find friends and family or consider hiring someone to help you until you’re ready to care for yourself.

    Take Care of Your Health

    • Make sure you understand your medications and wound care instructions.
    • Know if and when you will have in-home physical therapy and/ or outpatient physical therapy. Your case manager can answer these questions before you are discharged.

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    Preparing For The Hospital

    Cleaning Your Skin Before Surgery
    Before you go to the hospital for surgery, it is important to make sure your skin is germ-free. Using a product with 4% Chlorhexidine Gluconate (CHG), an antiseptic solution, greatly reduces the amount of germs on your skin and has been shown to reduce surgical site infections. "Hibiclens" is a common brand name that can be found at most pharmacies.

    Notes:

    1. Do not shave legs for at least 5 days before surgery.

    2. Do not use a loofah or wash cloth that has been sitting in the shower.
    3. It will recontaminate your skin.
    4. Do not use CHG if you are allergic.
    5. Do not use CHG on your face or genitals


    You will need to take three CHG showers at these intervals:

    • 2 days before surgery
    • Night before surgery
    • Morning of surgery


    Showering with CHG
    1. Shower with warm (not hot) water
    2. Shampoo hair and wash face with your regular products
    3. Rinse hair and body well
    4. Turn the water off
    5. Pour the CHG onto a clean, wet washcloth
    6. Apply CHG to your entire body from the neck down
    7. Wash for five minutes, paying special attention to the area where your surgery will be performed
    8. Turn the water back on and rinse thoroughly. Do not wash again with your regular soap after using CHG.
    9. After you shower, pat dry with a clean towel
    10. Do NOT apply any lotions, perfumes, powder, or deodorant to your body. This will inactivate the CHG. This is very important
    11. Wear clean pajamas after each shower and sleep on clean sheets
    12. Wear clean, freshly washed clothes to the hospital.


    What to Pack

    • Bring loose-fit clothing, nonskid, closed-toe slip-on shoes and toiletries.
    • Bring cases for glasses, contact lenses and dentures. You will need to remove them before your surgery.
    • Do not wear or bring wedding bands, jewelry or body piercings, or valuables such as cash, credit cards or checkbooks.
    • Pack a small overnight bag with your personal items, if needed.


    Medications
    • Bring your completed Medication Form you received in your pre-registration packet.
    • It is best not to bring your medications to the hospital. If you are concerned whether the hospital carries a special medication, bring it in its properly labeled pharmacy bottle so the hospital pharmacist can ensure it is safe to take during your stay.


    The Day Before Surgery

    • Before midnight, drink plenty of fluids to make sure you are hydrated.
    • After midnight, do not eat or drink anything.
    • Take only the medicines you were told to by the nurse or surgeon/ primary doctor—with a sip of water.
    • Shower with CHG the night before and morning of surgery, as described in Cleaning Your Skin Before Surgery


    Going to the Hospital
    • Patients are generally asked to arrive 1-2 hours before the scheduled surgery. Please confirm the arrival time with your surgeon’s office.
    • Go directly to the CPMC campus where your surgery is scheduled


    California Campus:
    3700 California St. San Francisco, CA 94118
    Check in at the Center for Outpatient Surgery on Floor 3
    Pacific Campus:
    2333 Buchanan St. San Francisco, CA 94115
    Check in at 2351 Clay St., Floor 6

    Your care, comfort and privacy are our main concern. Our goal is to make sure your surgery is within 30 minutes of the scheduled time. Sometimes there are delays. We will keep you informed if delays occur.
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    Follow-Up Care

    Your Surgeon

    Before you go home, your case manager will help you make a follow-up appointment with your surgeon for 2-3 weeks after your surgery.

    Date of appointment:

    Physical Therapy

    Depending on your needs, you may receive either in-home or outpatient physical therapy. Your care team will determine which physical therapy setting is best for you. Some patients may also need additional occupational therapy at home. Your care team will determine what type of physical and occupational therapy you need and whether you should receive it at home or in an outpatient setting.

    Date of appointment:

    Concerns
    If you have any questions or concerns about your recovery or any health problems after surgery, call your surgeon or come to the emergency room, located at CPMC’s Pacific Campus at 2333 Buchanan Street in San Francisco.

    Warning signs include:

    • Temperature higher than 101⁰ F or 38.5⁰ C
    • Increased redness and swelling around the incision
    • Changes in the amount, look or smell of drainage from the incision
    • Severe pain, difficulty breathing or swelling in either leg



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    To-Do Checklist

    Before Surgery

    • Preregister by calling our Patient Registration Line at 1-855-398-1637.
    • Complete the Medication Form.
    • Organize your house to make it easy to move around.
    • Ask for help from friends and family.
    • Buy groceries and prepare food for the first week home.
    • Arrange transportation.
    • Start washing with CHG (see Cleaning Your Skin Before Surgery)
    • Make sure you have slip-on shoes and clothes that are easy to put on.
    • If you smoke, stop smoking as soon as possible.


    After Surgery

    • Schedule or confirm your postoperative office visit with your surgeon.
    • Schedule or confirm your in-home or outpatient physical therapy session.

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    Health Care Provider Contact List

    Primary Care Physician:
    Name:
    Phone:
    E-mail:

    Surgeon:
    Name:
    Phone:

    Physical/Occupational Therapist:
    Name:
    Phone:
    E-mail:

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    Lodging And Transportation

    If you or your family members require an overnight stay in San Francisco, Hotel Kabuki and Holiday Inn are the lodgings of choice for CPMC.

    Hotel Kabuki
    1625 Post StreetSan Francisco, CA 94115
    Tel. 415-614-5423
    www.hotelkabuki.com
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    Holiday Inn - Golden Gateway
    1500 Van Ness AvenueSan Francisco, CA 94109
    Tel. 855-472-7645
    www.goldengatewayhotel.com
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    To receive the discount CPMC patient room rate at Hotel Kabuki, call 415-614-5423. To receive the rate at Holiday Inn, call 855-472-7645 and reference CPMC.

    In addition to discounted room rates, patients and their families have access to courtesy shuttle services from CPMC's Pacific Campus to both hotels. Shuttle service is available Monday through Friday, from approximately 6:30 am - 6:00 pm.

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