Knee Replacement

Before Surgery - After the decision has been made to proceed with knee replacement, there are several things that need to happen to ensure the procedure is performed safely and smoothly

  • Appointment scheduling

    • My office will contact you to confirm the operative day and set up the required preoperative testing and visits

  • Preop Lab Testing and Medical Clearance

    • My office will order several tests to ensure that you are in health is optimized. We will check blood and platelet levels, electrolytes, EKG, urine and nasal bacteria screens as part of this work up.

    • Medical clearance. This is either performed by your primary care physician or one of our internal medicine specialists. Using the information from the listed above your medical doctor will ensure that your health is optimized for surgery.  Your doctor may find abnormalities that need to be worked up further before proceeding with surgery. If you see a cardiologist for active heart disease you may require a separate clearance from this physician

      • Other requirements to proceed safely with surgery

        • Weight – BMI must be less than 40

        • Patient does not use nicotine or tobacco products

        • If diabetic the hemoglobin A1C must be below 7%

        • No open wounds or active infections

  • History and Physical

    • Usually within 2 weeks of surgery you will have another appointment to go over the clearance and tests that were ordered as well as ensure no changes in your health since then. I will also go over in detail the surgical process, expected postoperative course and obtain informed consent for the procedure.

    • After this visit you will go to the hospital to meet your anesthesia team

    • You will need to stop certain medications 7-10 days before the procedure

    • You will need to bathe with chlorhexadine wipes/soap 2-3days before surgery to decolonize bacteria around your knee

    • You will also use bactroban ointment in your nose 5 days before to decolonize the bacteria there

  • Total Joints Class

    • The hospital gives a class that goes over the details of what will happen and what to expect from the before surgery to when you leave the hospital. I recommend going to this short class.

  • Preoperative Templating

    • I will plan the bony cut angles to correct the deformity of the knee a few weeks before your surgery.  We need a standing xray that goes from your hip to your ankle to accomplish this. This is often not done with outside images. You may need new xrays so I can template appropriately.  Below is an example. By planning the surgery ahead of time I minimize surgical time and remove any guesswork.

Surgery Day

  • You will be told what time to arrive at the hospital the afternoon before your surgery day. It is important that you arrive on time or early. There are several things that need to happen before surgery

    • You will change into a gown

    • If there is excess hair around the surgical site it will be clipped

    • An IV will be placed

    • You will be given several medications to control your pain after surgery

    • Your anesthesiologist will see you

    • I will to mark the surgical site and sign your consent form

    • The OR needs to be cleaned and the equipment set up for your surgery

  • After all of the above has been completed you will be brought to the OR

Spinal Anesthesia

  • Your anesthesiologist will perform a spinal. You will go completely numb from the belly button down. You will also be given sedating medication to make you sleep. The benefits of this type of anesthesia are many:

    • You will not require an endotracheal tube and you will breathe on your own

    • You will require only very minimal sedating medications since the spinal removes any pain

    • You will wake up from anesthesia with no pain and little nausea from the light sedating medication.

  • After anesthesia is induced you will positioned on the operating table and into a special knee positioner

The Procedure

  • Before surgery you will be given antibiotics and medicines to reduce your risk for bleeding and infection.

  • The surgical detail is reviewed in another area of this website. The surgery entails removing up to 9 millimeters of bone from the end of the femur using 5 precise cuts and then capping it with metal that recreates the normal anatomy.  The top of the tibia is similarly shaved off and prepared for a plate to sit on this surface. A plastic liner is placed on top of the tibial component.

  • Now, instead of bone grinding on bone we have smooth metal gliding on plastic.

  • The cuts are planned to recreate your normal anatomy and correct the deformity.

  • The ligaments then need to be balanced through a series of releases to ensure the knee is not unstable. 

  • I will inject numbing medicine around the knee replacement to act as another layer of pain control.

  • Surgery itself will take between 40-60 minutes. You will be in the operating room longer than this for the setup and take down of the case. You will leave the operating room with a special sterile bandage that will not be removed until your follow up appointment

PACU

  • In the recovery area you will wake up from anesthesia in a hospital bed. The spinal will still be working. You will have no pain and will not feel your legs. As the spinal wears off you will be able to feel and move your legs. The numbing medicine around the knee will be active. You will have multiple pain medications ordered if you start to feel pain in the knee. You will likely be in the recovery area for an hour or two until you wake up enough to be transferred to the orthopaedic floor.

Orthopaedic Floor

  • Your pain will be controlled with several different medicines that work together to act on multiple sites of the pain cascade. Goal pain level should at or below 4 out of 10.

  • You will walk on your new knee replacement the day of surgery with the aid of a walker and physical therapy. You will find that the arthritis pain you had before surgery is gone and the soreness from surgery is manageable. 

  • Most patients stay overnight in the hospital and work with therapy again in the morning before being discharged home.  In order to go home you need to accomplish the following:

    • Pain controlled with the medicines we give you (you will go home with the same medicines)

    • Walk short distances safely with a walker

    • Eat and urinate without issue

  • 95% of patients go home the day of or day after surgery. I prefer that you go home instead of a rehab facility. Your infection risk is much higher if you go to a rehab center than if you go home.

  • You will be discharged with the following medications:

    • Aspirin 81mg twice daily – used to reduce risk for blood clots

    • Pain medication #1  - Tylenol 650mg 4x per day – Take as scheduled, no exceptions

    • Pain medication #2  - Naproxen 500mg 2x per day – Take as scheduled, no exceptions

    • Pain medication #3 – Tramadol 50-100mg every 6 hours – Take if you still have pain after the first 2 medications, Most patients require this medication for at least the first two weeks following surgery

    • Pain medication #4 – Oxycodone 5-10mg every 4-6 hours – Take if you still have pain after the first 3 medications. Most patients need this medication for the first few days after surgery. Many do not need it at all. This medication is the strongest but also has the most side effects such as nausea and dizziness.

 

 At home - first two weeks

  • Control your pain with the medications listed above. Remember to take the Tylenol and Naproxen regardless of your pain or how you think they work. These medicines help the stronger ones work more effectively if needed.

  • Wear your TED hose stockings for as much as possible. This will help reduce swelling.

  • Physical Therapy: You will need to start physical therapy to bend and straighten your knee as much as possible. Scar tissue will start to set up and the knee will try to get stiff. Depending on your home situation we can set up physical therapy at an outpatient facility or have home health nurses start this process at your home.

  • Walk with a walker. You may transition to a cane if you are able to walk without a limp.

  • Showering. Your bandage is water resistant. You can shower with this bandage. Just pat it dry with a towel afterward. Do not let water hit it directly or submerge in a tub or pool.

The bandage – This bandage is designed to stay on until your follow up appointment. It has antibiotic properties and as was put on in the sterile environment of the operating room. A little drainage on the bandage is normal. If the whole bandage fills up with fluid you should call the office to be seen by me.  I am the only one who should remove this bandage.   Below are examples of normal and abnormal appearing bandages.

Normal Dressing                                                                                                                                                                              Abnormal Dressing

   - Minimal drainage                                                                                                                                                                          - Saturated

First follow up appointment – 2 weeks after surgery

  • I will remove the bandage, remove the staples and place steri strips. I use staples because the front of the knee sees a lot of stress when you are bending the knee in physical therapy. Staples are stronger than the dissolvable sutures I use for hip replacements. I will make sure there is no infection present.

  • I will check your knee range of motion. Ideally I would like you to straighten the leg all the way and bend beyond 90 degrees.

  • You will be able to shower. No submerging the wound until it is completely scarred over usually 4-6 weeks.

  • I will check a standing xray. I am looking to see the parts are still in the appropriate position

  • We can refill any medications that you need

At home from week 2 to week 6

  • Continue aggressive physical therapy. This is the window in which you can regain as much motion as you can. The scar tissue is still very immature and can stretch. The motion you work for during this time will determine how much your knee bends forever.

  • Continue pain medications as needed. Remember to take Tylenol and Naproxen before the others. You may need the stronger medicines only after therapy.

  • I would expect a gradual improvement week by week. Occasional episodes of pain are common as you use your knee more.

Second follow up appointment – 6 weeks after surgery

  • I will check your motion and strength. Ideally I would like your knee to straighten all the way and bend to 120-130 degrees.

  • I will check another xray to ensure the parts have not moved and are still in appropriate position.

  • Most patients feel much better at this point that before surgery. There still is more healing to go but the arthritis pain will be gone and the surgical pain will be fading. You are approximately 70-80% of the way healed.

 

Driving – differs by which knee was replaced.

  • Left knee – for an automatic transmission, you can drive when you are off of your narcotic medicines. Usually around 2 weeks.

  • Right knee – you need to be off of your narcotic medications and have full ability to depress the brake pedal quickly and firmly if needed. Most patients reach this point at 4-6 weeks. I recommend caution when first driving again for the first time. Test yourself in your drive way before going on the open road.

Further recovery

  • It takes a full year for a hip or knee replacement to be as good as it will be. This is due to the scar tissue that needs to mature.

  • During the first few months you will still experience warmth, swelling, stiffness and fullness of the new replaced joint. This is from the extra blood flow going to the immature scar.

  • As the skin scar fades from a red or purple color to a faint white, the scar tissue inside the joint will do the same.

  • It is not uncommon to have occasional episodes of scar tissue mediated pain when being very active during the first 6 months.

I will check an xray at your year anniversary from surgery and every few years following that.

Dr. Justin Brothers performing hip replacement and knee replacement in Myrtle Beach, South Carolina. Need help with your hip or knee pain, contact Justin Brothers, orthopedic surgeon located in Myrtle Beach, SC. Justin Brothers is a knee and hip surgeon performing in the area of Myrtle Beach, South Carolina. Hip pain and knee pain can be solved by visiting Justin Brothers in Myrtle Beach, SC. Hip pain, hip surgery, knee pain, knee surgery, hip replacement surgery, knee replacement surgery in Myrtle Beach, SC. Justin Brothers, Dr. Justin Brothers can help your knee and hip pain today.

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