The Hip - book
Home » Joints » Knee » Total Knee Replacement – Day 1

Total Knee Replacement – Day 1

         blood draw: A blood drawing technician will draw your blood at 6 AM (will test for your red blood cell level
         - hematocrit - and possibly chemitry level).  Ask your nurse about your hematocrit (should be above 30 and if
         the hematocrit is below 26 we may recommend a transfusion)

         vitals and monitoring: The nurse or aid will measure your vitals (temperature, pulse, blood pressure, and
         respirations, as well as noting the oxygen saturation rate).  It is normal to have an elevated temperature for
         2-3 days after surgery.  Remember that 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) 

         bath: the nursing staff will give you a sponge bath.

         breakfast: Try to restart a normal diet.  If possible try to get out of bed.  This makes eating easier and lets the nursing staff
         clean your linen.Try to restart a normal diet.

         tubes: Tubes attached to your body will include nasal oxygen, an IV catheter, a Foley catheter (bladder catheter), and a 
         femoral nerve catheter.  As you progress with your recovery, these tubes will be removed.  The bladder catheter is removed
         once you are able to mobilize.  The nasal oxygen will be removed once your O2 saturation level is greater than 92-94%.

         physical therapy: The physical therapy service will see you about mid day and will teach you how to mobilize with a walker.  They will
         probably leave you in a chair for at least 2 hours.
         CPM - continuous passive motion: typically the CPM will already have been utilized.  The therapists will show you how to
         increase the range of motion to about 60 deg (with the eventual goal of 120 deg).  When in bed, the patient should keep the 
         CPM for at least 50% of the time.  If the machine helps you sleep, feel free to keep this running during the night.
         blood clots:  The nurse will give you a shot in the abdominal fat to prevent blood clots (Lovenox).   Ask her to teach you how to
         give these shots as they are often given for a week or two at home.  You are encouraged to move your feet back and forth for two
         minutes every 30 min (2 min during each TV commercial).   This will also help prevent blood clots.

         hospitalist: The hospitalist will continue to see you on a daily basis.  He may change around some of your home medications.

         wound dressing: Typically, the wound dressing is left alone for several days unless there is bleeding.

         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).

         Femoral Nerve Catheter                        CPM w/ Knee Flexed                 CPM w/ Knee Extended


Post Operative Day Two:

............        .                           .................                                  .........................                               ......................................... .........................................

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Monday, December 17, 2007 10:37 am