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Day of Surgery
What to Expect: The Day of Your Knee Surgery
Our team will give you complete instructions before your procedure. FOLLOW THESE INSTRUCTIONS CAREFULLY! If you have any questions, call the hospital or Dr. Lonner.
You will be asked to come in for surgery approximately two hours before your scheduled start time. This will give you time to check in with the Admissions Department and see the nurses prior to surgery. Please do not be late, as this may result in having to postpone your surgery.
Once you check in with the admissions clerk, you will be brought to the Day Stay Unit where you will meet with a nurse and change into a hospital gown. If appropriate, your knee will be shaved by a technician prior to surgery.
Approximately one hour before the surgery, you will be brought to the surgical floor where you will meet the Anesthesiologist and Nurse Anesthetist who will discuss the anesthetic options in more detail, insert an intravenous line, and administer antibiotics. You will also meet a nurse assigned to your case who will confirm that your surgical consent form has been signed and your knee marked to identify the limb on which surgery is to be performed. If you are feeling nervous, medications can be given to you by the Anesthesiologist to make you feel more at ease during the preparations for your surgery.
Your family or friends can wait in the Family Waiting Area where they will be given periodic updates by the hospital staff and called by Dr. Lonner when the surgical procedure is finished.
The majority of our patients receive a spinal and/or epidural anesthesia. If epidural anesthesia is used, the catheter is typically removed the morning after surgery, although it may be left in place longer, depending on your particular pain management circumstances. On occasion, general anesthesia and a local injection of a numbing medicine (femoral nerve block) may be given to help reduce the pain in the front of your knee.
Total knee and partial knee replacements typically take between forty-five minutes to ninety minutes, depending on the complexity of the surgery. The time in the operating room, however, will be longer in order to administer anesthesia, prepare the knee(s) for surgery, perform the procedure, dress the knee with sterile bandages and prepare you for transfer to the recovery room. The time in recovery will range from approximately two hours, when one knee is replaced, to as much as six hours, if both knees are replaced.
In the recovery room, you will be cared for by a team of nurses. You will receive intravenous fluid and pain medicine as needed. You will have a catheter in your bladder overnight to help you pass urine and allow the nurses to monitor your fluid balances. Except in rare circumstances, your knee will be placed on a machine which bends it, known as a continuous passive motion (CPM) machine. In some instances, such as revision or complex knee replacement surgery or if you have a bleeding tendency, we may insert a small temporary drain in your knee to collect fluid for 24 hours. If your pain is significant, we may use a pain pump which gives you an opportunity to control the administration of pain-relieving medications into the bloodstream (called, patient controlled analgesia [PCA]).
Blood Thinners
After surgery, we take several steps to reduce the risk of a blood clot forming in the veins of your lower extremities or dislodging and traveling (embolizing) to your heart or lungs. You will be given a blood thinner for six weeks. In general, Dr. Lonner prefers to use enteric coated aspirin (Ecotrin 325 mgs.) 2 times each day for 6 weeks. However, if you have a significant problem with stomach ulcers, are intolerant of aspirin, have a history of blood clots or pulmonary embolism, have a hereditary risk for forming blood clots, or a recent history of certain types of cancers, you may be put on a medicine called Coumadin, in which case your blood levels will have to be checked several times each week and the dosage adjusted accordingly. If you are placed on Coumadin, the blood level that is checked is called the INR, and in most cases we want it to be in the range between 1.5 and 2.0. In addition, while you are in bed during your hospital stay, both lower legs will be wrapped in specialized pumps that squeeze blood in a rhythmic fashion to help the blood circulate. Shortly after surgery, we will encourage you to get up and out of bed with assistance and pump your ankles back and forth, to further reduce the risk of formation of blood clots. Finally, if you are traveling by plane or taking a long car ride during the initial 6 weeks after surgery, we will send you home with thigh high compressive thromboembolic (TED) stockings to help reduce swelling and the risk of blood clotting.
After surgery, if you develop calf or thigh pain and swelling, please notify us because those signs and symptoms could signify the presence of a blood clot. If you develop shortness of breath or chest pain, you may have a pulmonary embolism (blood clot in the lungs) or a heart problem and you should inform us immediately and go to the nearest emergency room. In very rare cases (approximately 0.1%), death can occur from a pulmonary embolism.
If you have a history of recurrent or recent blood clots or pulmonary emboli, a special filter (Greenfield filter) may need to be inserted into a large vein in your body, the inferior vena cava, so that if a clot does form and embolize, it will likely be caught by the filter. Occasionally these filters can be removed after approximately four to six weeks.
If you develop a blood clot above the knee or a pulmonary embolus, you will likely be given a medication called Heparin, followed by Coumadin, for up to six months. Sometimes the medicine we use to prevent blood clots can cause bleeding. Please let us know if you notice bleeding from your surgical incision, black or red bowel movements, bleeding from your gums after brushing or from your skin after shaving. Additionally, redness around the incision may be a sign of a hematoma (collection of blood beneath the skin), irritation from the staples, or a superficial infection and this should be brought to our attention. An increased amount of swelling in the knee that was not present prior to your discharge may indicate that there has been bleeding within the joint or the development of an infection. If these signs develop, you should call us immediately so we can evaluate your knee joint.
Pain Management
Our intention is to control your surgical pain as best as possible without over-sedating you or making you feel nauseous, as we try to accelerate the recovery process. We would like you to be as comfortable as possible so that we can help you achieve your physical therapy goals. The spinal and/or epidural anesthesia that you will most likely have is one way for us to control pain. Additionally, we have been using a concept called preemptive analgesia, which is our effort to better control the pain before it gets too severe. When we meet with you in the office to schedule surgery, we will discuss whether you are a candidate to begin Celebrex and Oxycontin prior to surgery. If you are intolerant of Celebrex or Sulfa-based medications, you have had adverse reactions to Cox-2 inhibitors in the past, or your medical doctor prefers that we abstain from using it, then we will avoid Celebrex. If you are able to take these medications, you will be given two prescriptions preoperatively: Two days before surgery you will start taking two pills of Celebrex (200 mg tablets) at the same time. These should also be taken on the morning of surgery with a very small sip of water. Additionally, bring the vial of Celebrex with you to the hospital. You will also be given a prescription for Oxycontin (10 mg tablets), which you should begin taking the morning of surgery, once again with a small sip of water. These medications will be continued in the hospital, although it may be necessary to supplement these with other pain medications. As a general rule of thumb, you should request the prescribed pain medication when you feel the pain developing so that it can be controlled promptly. Waiting until the pain is severe will make it more difficult to control.
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