ARTHRITIS OF THE KNEE JOINT

You will wake up in the recovery room. You will be comfortable and usually surprisingly free of pain. You can not be visited in the recovery room, but can be visited as soon as you get to your room. You will be in the recovery room for about 2 hours. Some patients are admitted to the Intensive Care Unit (ICU) for 24 hours before being transferred to the orthopedic floor. This does not mean that their condition is critical, but only that Dr. Huddleston feels the need for closer monitoring because of their age or pre-operative medical problems that increase risk.

Knee Replacement Surgery use to be extremely painful. Thanks to the combination of the “pain cocktail” and minimally invasive surgery it is now almost painless!

 

Dr. Huddleston is fanatical about pain control, and does everything possible to keep your pain to a minimum. You will be amazed at how little pain you will have. There are two major reasons for this.

The first is that the surgery is minimally invasive, and less tissue is cut that can cause pain.

The second is the use of the pain cocktail, also known as the “Magic Cocktail”, which is a mixture of medications that is injected into all the deep soft tissues around the wound prior to closing the skin. The mixture consists of a long acting anesthetic, morphine and an anti-inflammatory medication. The pain-cancelling property of this technique is truly “magical”. Many patients have absolutely no pain at all after the operation.

As a back-up, in case you do have some pain, you will also have the PCA Unit (Patient Controlled Analgesia): a computerized device that attaches to your intravenous line. It enables you to self-administer a small dose of narcotic at the press of a button whenever you feel the slightest pain, eliminating having to call a nurse. Since only small doses of narcotic are given at a time, you will not be as drowsy as with big-dose injections every 3 hours. The PCA is pre-programmed for your weight and age, so it is not possible for you to over-dose. Most patients also receive an anti-inflammatory medication by IV for 48 hours. After 2 days, the PCA unit will be disconnected because it is cumbersome and impedes your walking progress. If necessary, it may be continued for a few more days. After it is discontinued, pain injections are ordered, to be given every 3 hours if needed. Pain pills are ordered for milder pain.

OTHER DRUGS

Drugs are also ordered for nausea, constipation, and sleep. If you run a fever you will be given extra-strength Tylenol.

All patients get stool softeners, but many patients still develop constipation and need a mild laxative on the second or third day after surgery. All patients are given antibiotics to prevent infection (see Complications of Knee Replacement Surgery) starting just before the operation and for a few days after the surgery.

In order to prevent blood clots from forming (see Complications of Knee Replacement Surgery), most patients are given Coumadin (warfarin), which is a blood thinner. The internist calculates the dosage of Coumadin by daily blood tests. If the blood becomes too “thin” then bleeding problems can develop. If you do form blood clots you will be given heparin intravenously and be confined to bed for about three days, and then physical therapy will be resumed.

If you are put on Coumadin the internist may want you to continue it for a few weeks after you leave the hospital. He will give you a “take home” prescription for the Coumadin, and order any necessary blood tests needed.

Your blood count (Hemoglobin) will be monitored on a daily basis for a few days, and you will be given iron supplements and blood transfusions as necessary.

DRAINAGE TUBES

Suction drainage tubes are usually placed in the wound to remove any blood which collects after surgery. Some of this blood will be filtered and given back to you intravenously. This technique is called "re-infusion". The drains are removed 2 days after surgery. Removal is not painful.

Many patients have difficulty passing urine right after surgery and catheterization is then necessary. For this reason, we may insert a urinary catheter (in most patients during anesthesia), and remove it on the second post-operative day. Removal is also not painful. We try to avoid catheters for longer than necessary because urinary infection can develop.

THE OPERATIVE WOUND

The wound is over the front of the knee and will be about four and a half inches in length. The dressings are usually changed after the drainage tubes are removed, and as often as necessary after that.

The physical therapist will get you up on the first or second day after surgery, and will teach you the right amount of weight to put on your operated leg.

Special pneumatic pumps will be applied to your legs in the recovery room, and will be kept in place for several days. They massage your calves every forty-five seconds. Most patients find them very comfortable. You may also wear special stockings. The pedaling exercise, the pumps and the stockings all help to prevent blood clots from forming in your legs.

After the surgery (usually on the second day) the leg is placed in a CPM (Continuous Passive Motion) machine which will gradually exercise your knee. This machine is not particularly uncomfortable and will help you regain your knee movement. The amount of movement that the machine goes through will be gradually increased over the course of your hospitialization. You will be taught how to increase the amount of bending by adjusting the controls on the CPM. Please try to increase the amount of bending as much as possible, even if it hurts to do so. Ask for pain medication if necessary to help you work on this. The therapist will come twice a day and exercise your knee out of the machine. You should plan to use the CPM machine for at least six hours out of each day. By the time you leave the hospital we like you to have at least 90 degrees of knee motion and good control of muscles about your knee.

Most patients by the second or third day after surgery no longer have an IV, and are feeling quite well.

EQUIPMENT YOU WILL NEED AT HOME

While you are in the hospital, a social worker and the physical therapist will help you decide what equipment you will need when you get home. You will need crutches or a walker to help with walking for about six weeks after surgery. Crutches are actually easier to handle, but most people feel more secure with a walker. A hospital bed is hardly ever needed at home, but we will be happy to order one for you if you want it. Most insurance plans cover it. We will provide a “reacher” to help you dress or pick things up off the floor. A toilet seat extension will be needed so that you do not sit too low on the toilet. Most patients are able to go up and down stairs when they get home, holding onto the rail. If you live in a two-story house you might want to move a bed downstairs and convalesce there. You will also need a thermometer and a shower stool.

You will be independent when you get home, able to dress yourself and able get in and out of bed unassisted. Do not expect to be an invalid. Get out of your pajamas each morning and put on regular clothes. Go places by car and do things. Walk as much as comfort will allow you. Get off your walker and cane as soon as you can do so safely.

Older patients, especially those who live alone, are advised to stay in the hospital’s Rehabilitation Unit for additional therapy and general care. This will, in any case, greatly speed your progress to full recovery. The Rehab Units at Dr. Huddleston’s two hospitals are superbly geared to the special needs of joint replacement patients. Medicare may cover your stay there. Most private insurance companies will not. In the Rehab Unit, a doctor who is specialized in physical medicine will see you daily. Your internist will also see you there regularly. If you need facility care, and your insurance does not cover the Rehab Unit we can transfer you to Lake Balboa Convalescent Hospital which is covered by all insurance programs including Medicare.