Thank you for making Hamilton Medical Center your choice for your healthcare needs. Through expertise, technology, and a caring touch, we have made it our goal to exceed your expectations as we care for you and your family. Call 706.272.6511 or email [email protected] for more information on class days and times.

If you have any questions, now or in the future, please contact Ashley Painter, Orthopedic Nurse Navigator, at706.272.6511 or [email protected].

Causes of Knee Pain

The most common cause of knee pain is arthritis. Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. Osteoarthritis is most common in people over 50 years of age and in people with a family history of arthritis.

Why a Knee Replacement?

When your everyday activities are being limited due to stiffness and pain, and you have found little relief from more minimally invasive treatments, it might be time to consider a total knee replacement.

What happens before surgery?

Preparing your home

• Remove all throw rugs and pick up all electrical cords and trip hazards from the areas of passage. Ensure there is a clear path throughout your home, which includes the bathroom, bedroom, kitchen, and living area.
• Make sure the handrails in the shower, bath, and stairwells are securely fastened. Having a stable chair with two arms to sit in after surgery is advised.
• An elevated toilet seat, a walker, and a shower chair are necessary. Arrangements can be made to have these items delivered to your home or to the hospital before you are discharged.

Additional preparation

• Do not smoke for at least a week before surgery.
• Joint Moves Pre-Operative Education sessions

Find out more by attending our next Joint Moves Weekly Pre-Operative Educational Session. This class is held on the second Thursday of each month at 2:00 p.m. and the fourth Tuesday of each month at 6:00 p.m. The class is taught by Orthopedic Nurse Navigator, Ashley Painter, RN. You will learn to prepare for before, during, and after your joint replacement surgery. Call 706.272.6511 or email [email protected] for more information.

Pre-Admission Testing

Blood work, a urinalysis, an EKG, and a chest x-ray will be administered as part of pre-admission. These tests will be done in your physician’s office or at the hospital in the pre-admission testing area. Please bring a complete list of all your medications (or the bottles) to your pre-admission visit.

During your pre-admission visit at Hamilton, your nose will be swabbed and sent to the lab to screen for antibiotic-resistant infections. Information specific to this test and the next steps taken if the results are positive can be found here. (hyperlink on the word “here) You will also meet with an Anesthesiologist during this visit.

Your primary care physician may ask you to discontinue medications like Coumadin, Plavix, and aspirin 5 to 7 days before surgery.

If you are experiencing any problems with your teeth, an evaluation with a dentist before surgery may be needed. Infections can enter the blood stream through the gums. Treating dental problems before knee surgery will decrease the risk of developing an infection in the knee.

Shower with Hibiclens (CHG) before surgery. On Page 8 within the booklet, there are specific instructions. Please follow these step-by-step.

The Night before Surgery

Do not eat or drink anything after midnight.

The Morning of Surgery

Upon arrival to the hospital, please check-in at the Admission desk. A pre-operative Registered Nurse (RN) will greet you and your family. A hospital gown and a warm blanket will be provided. The RN will start an IV. A sequential compression device will be placed on your non-operative leg to help prevent blood clots from forming in your legs. The RN will wash your operative leg and place sterile towels around it.

Antibiotics will be started through the IV. The surgeon will mark the surgery site and answer any questions you may have.

An operating room RN will transport you to an operating suite. The RN will ask questions about your surgical procedure. An anesthesia provider will be waiting in the suite. The anesthesia provider will monitor your vital signs throughout your procedure.

What happens after surgery?

After surgery, your surgical team will escort you to the recovery room where a post-anesthesia care RN will take care of you. A large pillow will be placed between your legs to remind you not to cross your legs. Once you are fully awake, you will be transported to your room.

IV fluids will continue the first day of surgery. Once clear fluids are tolerated, a regular diet will start.

Pain

During your hospitalization, your pain will be treated by a multimodal approach. This means that your doctors will use multiple oral, and possibly intravenous medications to treat your pain.

Your nurse will ask you to rate your pain using a pain scale so that you will receive the appropriate level of treatment for pain based on your physician’s orders. It is important that you communicate with staff regarding your level of pain and the degree of relief obtained. A common side effect of pain medication is nausea. Your physician will include orders for medication to reduce nausea, but it is important to take this medication prior to its onset. Please remember to take your pain medication with food.

It is important to start your pain medication before the pain becomes severe. It is also important to schedule your pain medication prior to physical therapy.

Most pain medications include acetaminophen. Adding additional Tylenol to this medication could affect your liver function. Please discuss this with your physician prior to taking.

You will also start receiving stool softeners during your hospital stay. These should be continued at home. A very common side effect of pain medication is constipation.

Diabetic Patients

Patients who have diabetes will have their blood sugar is monitored throughout their surgical experience. This will help with the healing process.

Activity

After surgery, it is very important that you take deep breaths and cough every hour while awake. The nurse will instruct the use of an “incentive spirometer.” This device should be used every hour while awake to help prevent pneumonia after surgery.

Once you have been sent to your hospital room, Physical Therapy will see you within 6 hours from the time you arrived in the Post Anesthesia Care Unit. They will provide you with a walker and assess the strength of your surgical leg. Most patients are able to walk at this time. The goal before discharge will be to walk at least 150 feet. Your surgeon would like you to get out of your bed for all meals and to walk at least 3 to 4 times a day. If you have stairs at home, please let physical therapy know. They will provide you with an assessment and further education to meet those needs. Please have family present during your Physical Therapy Sessions. Physical Therapy will see you again the next morning to continue your exercise program.

For safety, always use your walker until your therapist is in agreement that you are stronger to use another device. Never use your walker to pull up from your chair.

• Obtain a raised toilet seat or bedside commode, it will make it easier to get up and down.
• When you are going up or down stairs, use your stronger leg first.
• Do not turn or twist your operated leg.
• Continue to use your ice packs for pain and swelling, they should go home with you from the hospital.

Going Home

Discharge from the hospital will occur 1 to 2 days after surgery. Physical therapy will continue at home with a home health therapist or return for outpatient therapy. Someone will need to be at home with you for the first week.

Medicines

Prescriptions for pain and medicine to prevent blood clots are giving at discharge. Hamilton’s pharmacy (HMC Rx Care) can fill those for you.

Bathing

Your incision will be covered with a special dressing that is designed to reduce the risk of infection. This dressing may be changed prior to leaving the hospital and will remain in place until your follow up appointment with your surgeon. If your dressing becomes soiled or loose, notify your home health or your surgeon, as it will need to be replaced. You may shower, but do not take a bath or swim in a swimming pool.

Diet

It is important to eat a healthy diet including fruits, vegetables, and drink plenty of fluids after surgery. Constipation is a side effect of pain medicines. Your nurse will ask about bowel movements. It is important to make sure that your nurse is aware of the decrease or absence of bowel movements.

Follow-Up

A follow-up appointment with your surgeon will be conducted in 2 to 3 weeks. During this visit, the staples will be removed. He will check on your progress with walking and activity.

Do not drive until you are cleared to do so by your doctor. Do not drive if you have taken pain medication.

Call the Doctor

Please call your doctor immediately if you experience any of the following:

• Drainage from your incision
• A red, swollen, or warm incision
• Blood saturating your dressing
• A fever greater than 100.5
• An increase in pain
• A decrease in joint movement
• Toes or feet that look dark in color, feel cool to the touch, or are numb
• Pain or swelling in your calf muscles

If you develop shortness of breath, sudden chest pain, fast or irregular heartbeat, or difficulty breathing, call 9-1-1 immediately.

Going Home on Blood Thinners

Following your joint replacement surgery, your surgeon may send you home on medications to reduce the risk of blood clots. Blood-thinning medications are also called anticoagulants. Prior to surgery, some patients are already taking blood thinners for chronic medical conditions.  Your surgeon will advise you on when to resume those.

Your surgeon will have you start these medications the morning following your surgery. You may discharge on the same medication for a length of time determined by your surgeon. Aspirin is sometimes used.

Occasionally, a patient will have to use a blood thinner in a shot form. You and a family member will be taught how to administer this prior to leaving the hospital. Make sure you take this medication exactly as ordered, take it at the same time each day. Talk with your doctor before taking Advil, Motrin, Ibuprofen, Celebrex, Naproxen, Aleve, or Mobic. Some over the counter supplements may not be safe with your anticoagulants. Discuss all medications with your physician.

While on blood thinners, you will need to limit activities where you could fall, cut yourself, or suffer injury. If you develop a cut or laceration, you may apply pressure. Ice and elevation may help. If bleeding does not stop, you may need to call 9-1-1 for emergency assistance.

Should you develop a nose bleed, apply pressure and an ice pack to the bridge of the nose. If bleeding continues, seek medical help. If you have a fall, feel dizzy, weak or faint, or have confusion, blurred vision, or a severe headache, notify your doctor immediately. Also, notify your doctor if you experience the following:

• Easy bruising
• Bleeding from gums
• Blood in your urine
• Dark bowel movements
• Maroon or red nose bleeds
• Vomit that appears to be blood or a coffee ground material

They need to know if you are having bleeding from your surgical wound as well.

POSITIONING YOUR NEW KNEE JOINT

When resting in bed or sleeping, don’t put a pillow under your operated knee, unless you have been instructed to do so in order to perform a particular exercise. This can lead to an inability to straighten your knee and affect the way you walk.

While sitting, your knee should be either elevated or straight (with your leg on a footstool) or bent at a right angle (with your foot resting on the floor). Do not sit for long periods of time with your knee in a slightly bent position. Repeatedly moving your knee from a straight to a bent position is very helpful.

Avoid very low seating positions and use a chair that has arms that you can use to get into a standing position.

If you are having trouble straightening your knee, and/or if you tend to sleep in a “fetal” (curled) position, you may need to wear a temporary knee splint at night to keep your knee straight. Talk to your therapist for more information.

Three times a day, lie on a flat and firm surface with your leg stretched out flat. Put a towel roll under your heel. Stay in this position for 30 minutes.

***NEVER PLACE A PILLOW BEHIND THE KNEE***

Pillows should be placed lower under the lower calf and ankle.

WHILE IN THE HOSPITAL, YOU MUST HAVE YOUR NURSE OR PHYSICAL THERAPIST ASSIST YOU ANY TIME YOU ARE ATTEMPTING TO WALK OR TOILET.