Knee replacement surgery preparation means a lot of work. The physical and mental preparations require focus and dedication to helping you regain your quality of life.
In the first part of this case study, we looked at how Royce arrived to the decision to undergo total knee replacement.
The second part look at the extensive preparations needed for a successful surgery.
Prepaing for knee replacement surgery
My appointment with Orthopedic Physician, Dr. David Lionberger took place at Houston Methodist Hospital on October 21, 2020.
Dr. Lionberger took multiple x-rays of both knees and my right hip. He determined my left knee needed replacement as soon as possible.
Next, he described the surgery process to be done with assisted computerized robotics. Also, a type of uncemented prosthetic implant, the Zimmer Biomet Persona, would be used.
Exercises to prepare for knee replacement
Dr. Lionberger recommended doing at least three physical therapy sessions prior to surgery. The physical therapy sessions built strength, endurance, improved flexibility and range of motion.
This therapy helps improve surgical outcomes and gets the patient ready for the rigorous post-operative PT plan which started on day three after surgery.
Since I am a physical therapist practicing for 23 years, I devised my own “Pre-hab” plan.
I exercised 3-4 times per week and performed upper body, lower body and core strengthening as much as my arthritic knees could tolerate. Leg muscle and tendon stretching are necessary to elongate the hamstrings, quadriceps and calf muscles as well as endurance and cardio training. By stretching the muscle/tendons that cross the knee joint, you alleviate compression forces on the joint which increase pain and inflammation.
My goal was to lose 10 to 12 pounds before surgery and decrease joint compression forces on my knees. Compressional force on the knees is a function of our body weight.
When we run or jog, it’s roughly 3.75 times your weight in compressional force, but it’s still 1.75 times your weight when you are walking.
Meeting the knee surgery team
Later, I met with the nurse and received my surgery packet of instructions. My surgery date: January 12, 2021.
Set appointments with my Internal Medicine (IM) and Rheumatology physicians to get medical information for surgical clearance.
The IM doctor does full blood work, urinalysis, EKG, chest x-ray, stress test and pulmonary function test. The Rheumatologist provided her progress notes and a physical exam report. In turn, the reports went to Dr. Lionberger. Both of these appointments happened December 14, 2020.
The next appointments, with the Physician’s Assistant (PA) and the Anesthesiologist, were for final pre-operative clearance. The Anesthesiologist, Dr. Supkis, asked questions and did a thorough review of the medical information sent over by my IM and Rheumatologist.
The PA gave me final preparatory instructions including what medications to take and when to take them:
- Stop any over-the-counter blood thinning medications such as aspirin, Alleve and ibuprofen (Advil) 3 weeks prior to a knee replacement surgery.
- If you are using a prescription medication such as Coumadin or Plavix, discuss when to stop them with your prescribing doctor.
- While at Methodist Hospital, I will also receive a nasal swab Covid-19 test for surgical clearance. All appointments happened January 7, 2021.
Knee joint replacement camp
I attended a mandatory Joint Replacement Camp. A two hour session with the nurse and physical therapist as a Q & A regarding:
- what to expect following the surgery
- how to use the walker
- go up and down stairs
- get in and out of a car and more
The caretaker (my wife) attended to learn about what’s “normal” post surgery. This includes, but not limited to, bleeding, redness, bruising, pain, swelling and decreased range of motion.
Dr. Lionberger recommends keeping the knee elevated above the level of your eyes for the first two weeks. Exceptions include getting up to eat, drink, go to the bathroom, attend physical therapy (three times per week) and do your home exercise program (twice per day).
After seven days, my wife assists with wound care by removing the original dressing. Then, she’ll clean around the incision with hydrogen peroxide and re-dress the wound until the bleeding stops. When showering during the first two weeks, the wound area gets wrapped with Saran Wrap to keep the area as dry as possible.
The nurse and PT provided recommendations on the use of ice and the use of Sequential Compression Devices (SCD’s). SCD’s are pneumatic pads which strap around your calves and pump up briefly before deflating. The process repeats causing a “massaging” action to help keep the blood moving. This decreases the risk of developing blood clots.
This appointment happened January 7th, 2021 making for a long day at hospital.
Joining the total knee replacement club
As a physical therapist who treats patients with total knee replacement surgeries, I knew my day would come. Now, I have thousands of these former graduates lined up (some would pay) to watch me go through my PT.
I’m joining the club and becoming one of “them.”
The surgery preparation has been rigorous and distracting, but I feel optimistic. The down time and rehabilitation present major challenges, but with a “bone-on-bone” knee, this is the only way to regain the active life I choose to lead.
Post total knee replacement prescribed medication summary (Dr. Lionberger’s protocol; your physician may have a different protocol)
- Ambien: Take at night as needed for sleep
- Celebrex: Take twice a day for inflammation
- Norco or Hydrocodone: Take every four hours as needed for pain
- Tizanidine: Take for muscle relaxer as needed
- Zofran: Take for anti-nausea as needed
- Movantik or over-the-counter anti-constipation: Anesthesia and pain meds can cause serious constipation
- Baby Aspirin: Take one (81 mg) tablet once per day for blood thinner for six weeks
- DO NOT take medicines like Motrin, Aleve or Advil since they can interfere with the blood thinner.
Reducing the risk of hospital infection
Shower with chlorhexidine soap (CHG) beginning the day before surgery. CHG soap is simply any cleanser that contains the antibacterial chemical chlorhexidine gluconate. I’m using the Hibiclens brand which can be purchased at the local pharmacy.
The night before surgery (January 11, 2021), I washed my entire body (from neck down) with the CHG cleanser. It’s fine to wash hair with regular shampoo the night before. Do not wash your body with regular soap after using the CHG soap.
Dr. Lionberger asks the patient to drink a bottle of Ensure Max Protein shake no later than 6pm the night before surgery for hydration purposes.
On the morning of surgery (January 12, 2021), I washed my entire body in CHG soap except the head and neck. I did not wash my hair or apply lotions, perfumes, powders or deodorants.
For further hydration, on the morning of surgery (two hours prior), I drank a bottle of Ensure Pre-Surgery clear carbohydrate drink. This is very important considering that a patient must be able to urinate before being discharged from the hospital.
After returning home, maintain a clean environment, continue to shower with the CHG soap for 3-5 days, keep the wound clean and the surgical site dry.
Pre-planning for your knee replacement surgery
- Follow your doctor’s pre-planning instructions.
- Pick up your medications, CHG soap, walker, and pre-surgical drinks ahead of time.
- I recommend strategizing your food and drink. You need to eat healthy and nutritious foods which cover a wide variety of vitamins, minerals and high in fiber (remember, constipation). It is equally important to stay well hydrated, with water being probably the most viable. With proper nutrition and hydration, you are supplying your body with what it needs to heal as quickly as it can. My wife and I shopped for meals ahead of time to last at least 7 days post surgery. I will be drinking a lot of water with some G2 Gatorade mixed in.
In our next installment of the total knee replacement case study, we’ll talk about:
- knee replacement recovery
- physical therapy for the knee
- the decision to have his second knee replaced one week later