The following topics will assist
you in planning for the day of your total knee replacement surgery :
It is essential that you fully understand the risks, potential
complications and treatment alternatives related to joint
replacement surgery. The physician will discuss these issues with
you prior to surgery, usually at the time of your initial
consultation. Separate "consent" forms will be presented
to you by the physician's office and the hospital's admitting
department for your signature. The physician will not perform
surgery without a signed informed consent on file. Please discuss
any concerns which you may have with the physician prior to surgery
to ensure that you are making an informed decision regarding your
You'll be asked to donate one or two units of your own blood before
surgery. As with many surgeries, bleeding can occur during knee
surgery and you may require a blood transfusion. There are several
options available to replace the blood you lose during surgery and
these include: 1) autologous blood; 2) directed donor blood; 3)
banked blood; and 4) cell saver blood.
Autologous blood is your own blood that is set aside before surgery
so that it is available during or after surgery if the need for a
transfusion arises. Since the blood is your own, it has the
advantages over blood from other individuals in that it is incapable
of causing stimulation of antibodies to its contents (transfusion
reaction). It also carries no risk of transmission of infectious
diseases such as hepatitis or AIDS.
Depending on the number of units estimated to be needed for your
surgery, you will be advised to begin donating blood in advance of
the surgery. Your blood can be kept fresh for 42 days. The interval
between blood donations should be no shorter than one week, and the
last unit should be drawn no later than 5 days prior to surgery.
Patients who weigh less than 110 lbs. are eligible to give smaller
amounts (e.g., only 1/2 unit at each donation) and therefore may
need to start donating earlier.
The procedure of drawing blood takes about one hour each time,
although the first time will take about 15 minutes longer to
complete the paperwork. You will be asked to rest for 15 minutes
before leaving the donor center. You can drive an automobile if you
feel perfectly well but should inform the nurse if you have any
doubt. One week prior to when you begin your blood donations and
during the donation period until surgery, it is advisable that you
take iron (ferrous sulfate FeSO4) 325 mg and Vitamin C (ascorbic
acid) 500 mg - 1 of each, three times a day with meals.
Blood can be collected at the hospital or if you do not live
nearby, your blood can be donated at another blood bank and
transferred to the hospital prior to your surgery. Do not cut the
donation schedule too close because your donation schedule can be
delayed if you become ill or your blood count becomes too low. This
will not allow you to give the necessary number of units.
A special fee must be paid at the time the blood is drawn. These
charges pertain even if the blood is not transfused. If you donate
your blood at the hospital where the surgery will be performed, then
you are usually not required to pay the fees at the time of donation
as the charges are included as part of the hospitalization.
Autologous blood donation has been highly successful, and in most
instances has avoided the need for the use of homologous (another
Designated Donor blood is donated from someone that you designate
in advance, such as family members, relatives, or close friends.
These can be arranged if you are unable to donate the appropriate
number of autologous units before your surgery. However, the
designated donors must have a blood type that is compatible and meet
the strict donation criteria of the blood bank. These include no
history of previous blood transfusions, hepatitis, or jaundice, no
surgeries during the past 6 months, no anti-malaria medication in
the last 3 years, no previous donations for 56 days, and age between
17 and 66 years (over 66 requires blood bank doctor's approval). A
perfect match may be difficult to find, so your own blood is still
the best and highly recommended. Further, designated donor blood has
not been documented to be any safer than banked blood.
Banked blood (homologous blood) is donated by volunteers to local
blood banks. The donors are thoroughly questioned and tested for
potential transmissible diseases and the blood is carefully
screened. There is a minimal risk of transfusion reactions. The risk
of transmitting HIV is estimated to be 1 in 150,000 units of blood
and the risk for hepatitis is estimated at 1 in 30,000 to 1 in
Cell saver blood is your own blood that is collected during surgery
and reprocessed by a special machine. This blood can then be given
back to you during surgery. There are some limitations to this
system and the blood cannot always be used. Therefore, other types
of blood should also be available. Erythropoietin is a naturally
occuring hormone that regulates the production of red blood cells in
the human body. Recent advances in technology have provided the
basis for the development and production of recombinant human
erythropoietin, which is now available worldwide. It is a safe and
effective method of increasing the blood volume prior to joint
replacement arthroplasty for a selected population which cannot
donate blood or accept transfusions because of religious beliefs
(e.g., Jehovah's Witness).
If you are taking birth control pills, or anti-inflammatory
medications such as aspirin, Indocin, Motrin, Feldene, Naprosyn,
Voltaren, Lodine, etc., please discontinue their use at least one
week prior to surgery. These medicines can cause increased bleeding.
If you need pain relief, you can take Tylenol or your doctor can
prescribe narcotic pain medication.
Weight Reduction and Home
Exercises for the Knee
Keeping your weight down is not only good for your knee, it is good
for your general health. You should make an effort to get "in
shape" for surgery and, therefore, it is recommended that you
begin a preoperative program of exercise (only if it is comfortable
to do so). Easy isometrics (muscle tensing exercises) will help
maintain the strength of your leg muscles in preparation for
postoperative walking. The following exercises can be done in bed.
Exercise each leg remembering to breathe normally throughout the
exercise. Perform 2-3 times per day.
Gluteal Setting Exercise :
Squeeze your buttocks together
tightly, hold for ten counts. Relax. Repeat ten times.
Quadriceps Setting Exercise :
Tighten the muscle on the top
of your thigh by pushing the back of your knee down on the bed. Hold
for ten counts. Relax. Repeat ten times.
Hamstring Setting Exercises :
Keep the knee bent slightly.
Push your heel down into the bed and then pull toward buttocks. Hold
for ten counts. Relax. Repeat ten times.
Ankle Circles :
With lower leg resting on a towel roll, move
the ankle in a circle first in one direction, then in the other.
Repeat ten times.
Ankle Pumps :
Move the ankle up and down slowly. Repeat 10
You will be using your arms often during the postoperative period
while moving in bed and with the walker or crutches. Therefore,
strengthening your upper body is also important. Exercises should
While sitting in a chair, hold onto a bar that is
overhead and raise your buttocks off the chair. Repeat ten times.
Reverse Push-ups :
While sitting in a chair, place your arms
at your side and hold onto the chair next to your buttocks. By
straightening your elbows, lift your buttocks off the chair. Repeat
You can also do general strengthening exercises with small weights.
You may wish to consult with the hospital physical therapist before
surgery to discuss these and other beneficial exercises.
Preparing your home for post-operative recuperation is essential
since you will be using either a walker or crutches. Begin home
preparations at least a week in advance of surgery. You should try
using a walker or crutches around the house making sure that
important areas (bathroom, kitchen, bedroom) are easily accessible.
You may need to rearrange furniture or temporarily change rooms for
your convenience after your surgery. If possible, minimize the
number of stairs you must climb each day. Remove all throw or area
rugs that could cause one to slip. Bathroom modifications which may
be helpful include a shower chair, gripping bars, flexible shower
handle, non-slip floor surfaces or mats, soap bars with a string
attached and a long-handled scrub brush. If you live alone, you may
want to make arrangements to have a friend or relative stay with you
for a short while after your surgery. Ask for help ahead of time to
be sure that they will be there when you need them. This is
especially useful in meal preparation, carrying various items such
as plates and cups, putting on socks and personal hygiene. It may be
helpful to wear shirts with pockets and/or to drape a small canvas
or plastic bag draped over your shoulder for carrying smaller items.
Occasionally, patients are sent to a rehabilitation facility after
their surgery until they are stronger.
If you do not already have a disabled parking permit from the
Department of Motor Vehicles, you should apply for a temporary
permit several weeks prior to surgery. Our office can provide an
Knee replacement surgery is a major procedure and care must be
taken that you are in the best medical condition. You'll need to
have a general medical evaluation by an internist in order to assess
your health and determine your relative risk for anesthesia. The
type of anesthesia is a decision made between you, your internist
and the anesthesiologist. Your medical evaluation should occur two
to three weeks prior to your surgery. Please arrange to have this
physician send to our office, prior to your pre-operative
orthopaedic examination, all test results as well as a note which
clearly states that you may undergo the proposed surgery. Your
surgery may be postponed if our office does not receive the test
results and/or surgical clearance timely. If you do not have a
regular medical physician, we can provide a referral.
You may be required to undergo a pre-operative orthopaedic
examination in our clinic. If so, this appointment is usually
scheduled on the day before surgery. At this time we will review the
proposed surgery with you and answer any last minute questions you
may have. We will also review your medical evaluation, laboratory
tests, x-rays, and obtain any other tests or x-rays that are
necessary. If you have blood transferred from another blood bank we
will check that it has arrived. You will need to sign a surgical
consent. Finally, you will be directed to the hospital's "Pre-Op"
unit for pre-admission and instructions. The nurse will give you
instructions for the evening before your surgery and show you where
to report the morning of your surgery. If you do not live locally
and wish to stay in the area on the night before surgery, please ask
our office for assistance at the time you schedule surgery. The
hospital may have a guest room available on a first-come,
first-served basis at nominal rates for your convenience which we
can reserve for you or we can provide information regarding nearby
It is imperative that you not eat or drink anything after midnight
(12:00 AM) the night before surgery. This helps to prevent potential
nausea and vomiting from occurring during surgery which could cause
What to Bring to the Hospital
The most important item to bring is a pair of comfortable, sturdy
bedroom slippers with non-skid soles! The Physical and Occupational
Therapy Department will provide a walker or crutches, raised toilet
seat, reacher and other equipment as needed. To enhance your
postoperative therapy, a knee-length robe or gown is recommended. Do
not bring floor-length robes as they make walking difficult. Ladies
may want to bring a camisole or lightweight cotton shirt to wear
under the hospital gown for added warmth. Leave all jewellery at
home! A package containing personal care items is provided although
you may want to bring your own hair brush. Loose fitting pyjamas or
sweats are useful to wear on the way home as are a comfortable pair
of shoes. Program guides for television viewing are available. Of
course, good reading material may help pass the time more quickly!
If you take medication for any condition other than your arthritis,
then be sure to bring it with you to the hospital, or bring a list
of your medications and dosages with you to the hospital.
- The Day of Surgery and Postoperative Course
- Physical Therapy
- Follow-up Examinations
- Medication Issues