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    Knee Replacement

    Sutter Health CPMC is a Bay Area leader in joint replacement surgery. Our orthopedic surgeons perform over 1,000 knee, hip and shoulder replacements annually. Joint replacement surgery is performed for individuals of all ages, from young adults to seniors. Our goal is to help you get back to living your life, free of joint pain.

    What Is Total Knee Replacement?

    A total knee replacement is a surgical procedure in which the weight bearing surfaces of one’s knee joint are replaced with an artificial joint (prosthesis). 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.

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

    The surgery takes one to two hours, and your hospital recovery is from one to two days. Most patients go directly home from the hospital. By planning ahead, and following the steps outlined in this booklet, you can help ensure a successful knee replacement.

    Knee before surgery and knee after replacement surgery
    Knee joint before (left) and after (right) knee replacement surgery.
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    Before Surgery

    You will be contacted by a Pre-Admission Testing Nurse and a Financial Representative about two weeks before your surgery. Make sure you have an up-to-date medication list with drug names and dosages to review with the nurse. Have your insurance information ready when you speak to the financial representative. The nurse will take your health history and answer your questions by phone. The nurse may ask you to complete required medical testing (e.g. EKG, blood, urine and other tests) before you come to the hospital.

    You need a physical exam with your primary care doctor within 30 days of your surgery date.

    Medications
    Once your surgery is scheduled, CPMC will send you a preregistration 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. Please be sure to include drug allergies, all prescriptions, over-the-counter medicines, vitamins and herbal supplements.

    Note: If you have diabetes or are taking blood-thinning medicines, please tell your primary care doctor.

    A blood transfusion is sometimes needed to replace blood loss from surgery. If you have any concerns about blood transfusions, speak with your surgeon before surgery.
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    Preparing For Surgery

    Prepare Your Home

    • Housekeeping and Food: You may need help with groceries, meal preparation and housekeeping for several weeks. Find friends and family or consider hiring someone to help you until you are ready to care for yourself.

    • 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 where they are easy to 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.

    • Arrange for care of your pets as needed.

    Bathroom
    • Place a nonskid bath mat in your tub or shower

    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.

    Determine Who is Going to Help You Get Home
    Patients who undergo joint replacement surgery typically are discharged from the hospital in the morning on their discharge date. 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.

    Joint Replacement Registry
    Joining the Joint Replacement Registry provides Sutter Health CPMC with vital information that helps us and other hospitals track outcomes and identify how well certain surgical techniques, medication and orthopedic implants work. Your surgeon and CPMC hope that you participate in this survey that begins before your surgery and then follows up with you at 6 months, 12 months and every year after that. Please see the phone number on the insert in this booklet to begin the survey.

    Total Joint Class
    There is a Total Joint class taught by one of our nursing or physical therapy staff every Monday. Our patients who attend find it very helpful in assuring a smooth experience from preparation for surgery to discharge home. Please see the insert in this booklet to confirm your place in one of our classes.

    Take Care of Your Health
    • Complete any dental work in progress before surgery. You may need antibiotics prior to having any future dental work to prevent infection.

    • Check with your primary care doctor and surgeon about the medicines, vitamins and supplements you are taking now. You may need to stop taking some of these medicines including non-steroidal anti-inflammatory drugs (NSAIDs), any drugs that contain aspirin, and blood thinners at least one week before surgery.

    • If you have diabetes, make sure you take your oral diabetic medicine the day before surgery but not on the day of surgery. If you take insulin, please check with your primary care doctor for detailed instructions.

    • Consider stopping smoking before surgery.

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    Leg Strengthening Exercises

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

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

    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  xercise
    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.


    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. Repeat with other leg to complete set.


    long arc quads
    Long Arc Quads
    Straighten operative leg and try and hold it for 10 seconds. Repeat with other leg to complete set.


    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. Repeat with other leg to complete set.


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    Preparing For the Hospital

    What to Pack

    • Bring loose-fit clothing, nonskid, closed-toe 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.

    • Bring personal medical device(s) such as CPAP machine and inhalers.
    • Label all your personal items.

    Medications
    • Complete and bring the Medication Form you received in your pre-registration packet.
    • It is best not to bring your medicines to the hospital. If you are concerned whether the hospital carries a special medicine, bring it in its original labeled pharmacy bottle and give to your nurse.

    Cleaning Your Skin Before Surgery
    antispetic to clean 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. Do not use CHG if you are allergic and do not put it on your face or genitals.
    Notes:
    1. Do not shave below the waist for at least five days before surgery.

    2. Do not use a loofah or wash cloth that has been sitting in the shower.

    You will need to take two CHG showers at these intervals:
    • Two days before surgery.
    • Night before 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 on to a clean, wet washcloth. Apply CHG to your entire body from the neck down
    6. Wash for five minutes, paying special attention to the area where your surgery will be performed
    7. Turn the water back on and rinse thoroughly. Do not wash again with your regular soap after using CHG.
    8. After you shower, pat dry with a clean towel
    9. Very Important: Do NOT apply any lotions, perfumes, powder, or deodorant to your body. This will inactivate the CHG.
    10. Wear clean pajamas after each shower and sleep on clean sheets
    11. Wear clean, freshly washed clothes to the hospital

    Things to Do the Day Before Surgery
    • Before midnight, drink plenty of fluids to make sure you are hydrated.

    • Follow your surgeon’s instructions on when to stop eating food and drinking fluids.

    • The morning of surgery. Take only the medicines you were told to by the nurse or surgeon/primary care doctor—with a sip of water.

    Going to the Hospital
    • Patients are generally asked to arrive one to two hours before the scheduled surgery. Please confirm the arrival time and surgery location with your surgeon’s office the working day before your surgery.
    • Go directly to the CPMC campus where your surgery is scheduled.

    At the Hospital
    Anesthesia
    The anesthesiologist will meet with you and your surgeon about an hour before surgery 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 cases, your doctors may use general anesthesia.

    Hospital Room & Equipment
    Following surgery, your care team may use certain medical equipment.
    • Sequential Compression Device (SCD) consists of inflated sleeves wrapped around your legs while attached to a pump. This helps blood flow from your legs while you’re in bed to prevent blood clots.

    • Continuous Passive Motion (CPM) machine: may be used after surgery to help increase motion in your knee and reduce knee stiffness. The CPM machine will move your knee while you are in bed.

    • A Foley catheter for draining urine may be inserted into your bladder
      during the surgery. It is usually removed the first or second day after your surgery.

    You will have a nurse call button at all times. Always ask for help when getting up.

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    Your Team at CPMC

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

    Your nurse case manager helps you make arrangements for going home, such as: home therapy, medical equipment and perhaps extra help at home.

    A rehabilitation therapist will visit you one or two times a day to teach you how to safely: get in and out of bed, transfer to a chair, walk with the appropriate assistive device such as a walker or crutches, and teach you how to safely perform daily living activities.
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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 focus on getting around safely on your new joint. When you are comfortable, you are better able to walk, breathe deeply and cough.

    Constipation after surgery can be a problem due to inactivity and pain medicines. We recommend that you take a stool softener at least daily when you get home, drink plenty of fluids, and eat fresh vegetables and fruits. Laxatives may also be necessary. Ask your doctor or home care team for advice if you become constipated.

    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 bad to take your pain medicine.
    • Good pain control helps you recover faster.

    • Tell your nurses and doctors if you have pain.

    • If your pain suddenly gets worse or you experience.


    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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    Follow-Up Care

    Your Nurse Case Manager will assist you with your going home plan and home care needs based on what your insurance provides.
    A follow-up appointment with your surgeon for two to three weeks after your surgery will usually be made before you leave the hospital.

    Therapy
    Some patients may need additional therapy at home. Your care team will determine what type of therapy you need and whether you should receive physical and/or occupational therapy at home or in an outpatient setting.

    Concerns
    If you have any questions or concerns about your recovery or any health problems after surgery, call your surgeon. For urgent issues, consider coming to the local emergency room.

    Warning signs include:


    • Temperature higher than 101ºF or 38.5º 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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    Therapy Goals

    The focus of our rehabilitation program is to help you learn to carry out your daily life activities on your own as much as possible. Usually, the rehabilitation therapist will see you two to three times a day. Once you meet the following goals, you are ready to go home.

    1. Get out of bed.

    2. Walk in the hallway with a walker or crutches.

    3. Climb up and down stairs safely.

    4. Dress.

    5. Use the toilet.

    6. Stand for a short period of time.

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    Activity Restrictions After Knee Replacement

    Follow these instructions and check with your surgeon about how long you need to keep these restrictions.

    • Do not twist the knee.
    • Do not place a pillow under the knee.

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    To-Do Checklist

    Before Surgery

    • Make appointment with your primary care doctor for a physical exam within 30 days of your scheduled surgery.

    • Start pre-operative exercises.

    • Sign up and complete the Joint Replacement Registry survey. (See booklet insert for details.)

    • Confirm your spot at one of our Total Joint Classes (See booklet insert for details.)

    • Complete the Medication Form.

    • Organize your house to make it easy and safe 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 closed-toe shoes and clothes that are easy to put on.

    • If you smoke, consider stopping as soon as possible.


    After Surgery
    • Keep your surgical dressing dry until your postoperative office visit
      or as directed by your surgeon.

    • Schedule or confirm your postoperative office visit with your surgeon.


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