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Total Knee Replacement: A Guide for Patients

What Should You Know Before Your Surgery? 

        
How We Protect You From Infection
        How We Protect You From  Blood Clots:

        Your laboratory results
                - your hematocrit should be between 30 and 45%
                - if your hematocrit drops below 25-26% during your surgery, we may recommend a blood transfusion.
                - nasal swab: Your nasal swab should be negative for MRSA. 

       What type of knee is your surgeon going to use?
        
       What happens when I arrive to the hospital?
                           
       When you arrive at the hospital, you will be taken to the preoperative holding area.  Here you will be given
        an IV in your arm, and your operative knee will be shaved and cleansed with chlorohexidene (antiseptic). 
        You will be asked several times if you have any allergies and which is your operative knee (right or left). 
        Your operative knee will be marked with a magic marker.
        Anesthesia: Your anesthesiologist will discuss the option of a spinal anesthesia versus a general anesthesia.

        When the surgery is completed, your family will be notified.  Typically, you will remain in the recovery room for up to 2 hours. 
        During this time, the anesthesiologist will insert a femoral nerve cathether, inorder to relieve your pain during the post op period.

         

 Hospitalist Physicians:    After your recovery is complete, 
 you will be taken up to the surgical floor. Here you will meet
 your nurse and you will see one of our hospitalist physicians.
 He will manage your medical (non orthopaedic) problems.
 Typically he will order evening blood draw that will measure
 your hematocrit (red blood cell percentage) and a chemistry
 panel (measuring kidney and potassium levels).

  
         Pain Control:
Your pain will be controled with a femoral nerve catheter and by a combination of narcotic
         medications.  You will have the choice between oral narcotic pills and IV narcotics such as morphine and
         demerol. You can also request IV Toradol, which is an IV antiinflammatory (similar to IV advil).
         CPM - continuous passive motion: you will be introduced to a CPM machine which provides continuous knee motion
          while you are in bed.  The goal of this machine is to rapidly improve your knee's range of motion.  Many patients feel that
          the CPM dramatically improves pain control (typically the CPM is set for 40 deg of motion).

         Nausea: You only have to ask the nurse for an IV mediation to address nausea.
         Monitoring:
                The pulse oximeter machine will measure a continuous heart rate and blood oxygen level.  The pulse should be
                 below 100 and the oxygen saturation should be above 95% (or you will need oxygen).
                 Occassionally telemetry monitoring (battery operated heart wave monitoring) is needed if there is an irregular heart beat.
          Antibiotics: You will receive 24 hours of IV antibiotics (either Cefazolin or Vancomycin) to guard against infection.
          Blood Clots: After your surgery, we will apply a soft pressure device (SCD) to your feet.  This will intermittently squeeze the
          blood out of your foot, which helps to avoid the creation of blood clots.

Post Operative Day One
  
Post Operative Day Two:

Post Operative Day Three:

Post Operative Day Four and Beyond: