Tips for a Successful Total Knee Replacement Surgery
Journey to Knee Replacement Surgery
No one wants to have surgery, but sometimes, we have no choice. The pain in the knee, shoulder, or hip is unbearable, and all you want is to hopefully be pain-free one day.
I am not a medical professional — I am a coach. This article is based on cold, hard facts of my husband's joint replacement surgery. It was quite an adventure, and we learned a lot along our journey. We continue to learn each day.
I acquired so much information that I thought it was best to share with others and hopefully help to ease their apprehension regarding surgery. I learned tips and tricks of the trade from nurses, techs, doctors, and our surgeon.
If you are a caregiver or member of the team, as I was, this information will help you. I will refer to you as the coach. You are a vital part of the healing process. Your patience with the patient is mandatory for a successful surgery.
Always remember there is always sunshine at the end of a storm. One day, you will look back at your experience and be very thankful you got 'er done.
Preparing for Total Knee Replacement Surgery
First and foremost, I cannot stress enough the importance of pre-surgery physical therapy (PT) for your knee. My husband, Dave, went to PT for five months before his surgery. He had at home exercises, which he did religiously. At the start of PT, we had hoped that therapy alone would strengthen his knee and that he could forego surgery.
In his case, PT didn't, but it did help in many other ways. Therapy strengthened his core, his hips, his quads — the muscles surrounding his knee — everything except for his actual knee. All the muscles that were needed for a speedy recovery were prepared for action. When it came time for surgery, he was already ahead of the game.
I firmly believe that due to Dave's 5 months of PT (pre-surgery) is why he was discharged from the hospital 24 hours ahead of time. A shout-out and thank you to Mike of Sports Medicine and Rehab at Florida East Medical Plaza for his therapy skills and for being a huge part of Team Cap!
It's very rare for a Total Knee Replacement patient to be released within 48 hours after surgery. Dave was. He amazed the nurses with how quickly he was up and walking. He walked 3,000 steps while he was in the hospital. This impressed his Hospital Physical Therapist.
Obviously, pre-PT is not for everyone. It all depends on your pain tolerance, determination, and motivation. But, if at all possible, I suggest you look into it. Physical Therapy prior to surgery is a gift to yourself.
This article is our journey to a new, titanium, bionic knee. All patients are different. Situations are unique. Hospitals, surgeons, and pre-testing vary depending on the state, city or country you live in.
In the US, the typical stay in a hospital for total knee replacement is 3 days. In South Africa, it's 2 weeks. It all depends.
Dave's surgeon actually took a photo of the femur and he said it was one of the worst he's ever seen. His femur was bone on bone and that created a rut that caused an abundance of pain. I saw the photo, it wasn't pretty.
Cap preparing for surgery
Team Cap! Dr. Sean McFadden and Dr. Liz Clay
Have you had Total Knee Replacement?
Tips for Knee Replacement Surgery
Request recommendations for the Orthopedic Surgeon who might perform your surgery. If you aren't comfortable with the first choice, continue on to the second choice. Dave's surgeon Dr. Sean McFadden of Jewett Orthopaedic Clinic in Orlando was our first choice. He came with a boatload of praises and good reports. I spoke with many former patients who had only good things to say about his surgical techniques and success rates. We didn't select him because he was also a Captain America fanatic, but it was nice to know he also believed in super strength. Needless to say, we didn't have to shop around for a surgeon.
If the hospital you will be having surgery at offers a Orthopaedic Surgical Educational Class, do make time to attend. Florida East offered the class. It was well worth the 2 hours. We learned so much, such as what to expect before, during and after surgery. You will have the opportunity to meet other patients who will also be having surgery and you could exchange notes with them. If your hospital doesn't offer the class, I think you should suggest they start. Our class was taught by Sher Bent, who happened to be a longtime friend of mine. There was not one dull moment with her as our head coach!
Plan ahead for surgical pre-testing. Most surgeons require a cardiac clearance which includes a stress test. Since Dave wasn't able to stand on the treadmill, he had a chemical stress test. This was stressful for us. It required 3 visits to the cardiologist which includes the meet & greet. Then, we had to go twice for a CCTA Scan since Dave has an unusually fast heart rate. In the end, it all worked out. If you already have a cardiologist, you are one step ahead of the game. We didn't.
Purchase a binder or folder to bring with you to all visits to keep all your paperwork organized and in one place. This will come in handy when you go for pre-registration, which is usually a few days before surgery. Again, protocol for each hospital is different.
If you are overweight, try to lose some weight prior to surgery. Our knees support much of our body weight. The less weight it has to carry after surgery helps speed up healing.
Prayers and Positive Vibes — Well Wishes are Always Welcome!
Preparing for hospital stay
- Pack lightly. Chances are you won't be out of bed until the second day. Both men and women who have the surgery should plan on wearing shorts during their stay. It's easier for you and the nurses to check the surgical site and during treatment.
- Prepare ahead by getting extra sleep, if that's even possible.
- Some hospitals allow the coach to stay for the duration of the visit. Our hospital did. So the coach should pack snacks, a book, bring a warm blanket and prepare to not get much sleep.
- If you use a C-Pap machine, you should bring it along.
- Bring ear plugs or headphones.
- Enlist family members or friends to bring you meals from the outside. No one likes hospital food. My daughters brought us subs for dinner one night and a pizza the next day for lunch. They spread some sunshine on our days.
- Bring nutritional drinks (Boost, Ensure...) with you or have your doctor order them with each of your meals. Even if you don't like them, try to drink them anyway. Your body will appreciate the nutrients.
Knee Replacement Coaches are a Vital Part of the Team
Do your research. Allow Google and YouTube videos to help guide you through the surgical process, just don't allow them to instill fear in you. Use your best judgement when using search engines to acquire knowledge of your upcoming surgery.
Have a coach whether it's your mate, sibling, parent or friend. A coach is your voice when you can't use yours. A coach will be by your side and will allow no harm to come to you. They will keep track of appointments, be your chauffer, administer medications, plan your meals, calm your fears and make you smile. Having a caring coach will allow you to heal much quicker. As Coach Sunshine, I checked into the hospital with Dave and didn't check out until he did.
As the coach, you should be mentally prepared to bring along some tough love. Not right away of course, but over time. Pampering the patient will not benefit them in the long run. No one likes seeing loved ones in pain, but they need to work through the pain in order to bounce back faster. It's actually OK to stand on the knee and leg right after surgery, it's going to hurt, but using and standing on the leg will not damage it.
Coaches should never feel intimitated at any time by medical professionals. They encourage your questions and concerns. They appreciate a hands-on coach. Ask questions. Take photos. Document or journal the surgery because chances are the patient will not remember much. By the time you arrive at the hospital and then get discharged, it will fly by. It's best to write down all important information to reference back to it at a later date, if needed.
Check with your insurance company regarding post surgery visits at home with a traveling nurse and physical therapist. We had both of them visit the day after surgery. They both provided great advice and tips.
Team Cap! Have a surgery support team in place
Basic Knee Exercises which should be done slowly and while in bed. Always check with your doctor or therapist before attempting any post surgery exercise
Point toes towards you and down towards the surface
Helps prevent edema which is common after surgery
Tighten thigh muscles, pushing knees downwards
Hold for 5 seconds. Helps tighten the quads
Bend Knee and pull towards buttocks
Hold for 5. Helps strengthen thigh muscles
Bend knees and raise buttocks as high as you can
Hold for 5. Helps strengthen the core muscles
Continuous Passive Motion - CPM Machine
Mobility Exercises for Total Knee Replacement
What is expected of a post-surgery Total Knee Relacement patient
Below was Cap & Coach Sunshine's checklist that was given to us by Florida East Orthopedic Dept. and it was our challenge for the first 48 hours. In order to be discharged from the hospital you will most likely need to accomplish a few tasks:
- Be able to get in and out of bed with assistance.
- Have your pain controlled with use of pain pills only. Not a pain pump.
- Be able to get on and off the toilet with assistance.
- Urinate and have a bowel movement.
- Bathe and dress yourself with assistance.
- Eat and drink.
- Be able to walk with a walker, crutches or cane with assistance.
- Go up and down stairs with assistance, if you have them at home.
Dave aced this test. Except for a BM. As soon as he was home, that task was completed.
More tips for Total Knee Replacement
Normally you will have a CPM (Continuous Passive Motion) Machine delivered to your home for post surgery healing. Be sure and use your machine as the doctor prescribes. Some patients neglect to use it because it might be to heavy or awkward or just out of fear of doing something wrong. The CPM delivers a passive movement to your leg and allows the scar tissue to heal in the appropiate manner. You will be glad you used it.
Compression socks at home are a must. They help prevent clotting and are useful for edema (leg swelling). Again some patients don't use them because they could be difficult to place over the foot and onto the leg. Here's a tip for you...take a freezer size ziploc bag and cut the zipper part off. Place the bag over the feet. Then place the sock over the bag. It should slide right over. After the sock is in place just pull out the bag and save it for next time. Socks should be worn all day and removed at bedtime. This was our doctors order. Your physician might want you to wear them only at night. It all depends on the patient.
You will be using a walker after surgery. Most likley a cane, too. You might also be required to use crutches. If you've never used these walking aids before, if at all possible, try practicing with them before surgery. By learning to use these aids you will be a step ahead with your therapy. By the way, a cane is used on the opposite side of the injured leg. If your right knee is bum, use the cane in your left hand. Ditto for left leg. We learned that after a few months of using the cane in the wrong hand. Also, the walker should be aligned to hip level. Your posture should be erect, you should not slouch while using a walker.
Having a portable bedside commode at home will be very useful and not just for using the commode. The legs are adjustable so you could use it for a comfy seat anywhere in your home. You could also use it to take showers.
Our insurance company covered the cost of the cane, CPM, commode and hot/cold therapy pack. Some items will be returned about 21 days post-surgery. Hopefully your insurance will cover your therapy aids also.
Make time to recognize the members of your surgical team who go above and beyond to assist you during your recovery. Two of our favorite team members are Lana, who was the floor nurse and offered much advice. She was a bit anal, which is why we appreciated her even more. Jana, the Hospital Physical Therapist offered a wealth of information to Dave and his Coach. We continue to use her tips today and will in the future. Make sure they know that their dedication is appreciated.
Team Cap! Favorite Nurse Lana and Physical Therapist Jana
Knee Incision post-surgery
Hang in there...Your new bionic knee will learn to adapt.
Any surgery is stressful. But, total knee replacement is supposedly, according to what the nurses told me, the most painful. Imagine yourself down the road, walking pain free and how you made the best decision for yourself and hopefully your stress levels will lessen.
Most importantly is to hang in there. Don't panic. Don't throw in the towel. Also never, ever rest your leg on the bed in a bent position. Ever. Your muscles have been severed. They need to heal in a straight leg position. Not heal in a bent position, because you will end up walking funny.
Lots of ice is needed to help reduce swelling and pain. You'll be using a Cold Therapy Pack, but I also purchased soft gel ice packs to use instead of always using the therapy pack. You should store the gel packs in the freezer. Purchase two or three so that you'll always have one available. You could always use them for picnics or lunches once you are healed.
Chances are your hemoglobin will drop after surgery. It's very common due to blood loss. Even though knee surgery has less blood loss than hip surgery. Don't panic. Your hemoglobin will bounce back on it's own with adequate rest and nutrition.
My husband was an outstanding patient. His coach was superb. We got 'er done. He isn't your oridinary orthopedic replacement patient. Dave was diagnosed with Stage 4 Prostate Cancer six years ago. In October of 2012, he was given 4-10 months to live by his Radiation Oncologist after the cancer had spread to his brain. July 2013 was month 10. Due to his amazing Oncologist and the right treatment path, Dave was able to have his knee replaced and will one day be mobile without relying on a walking aid or wheelchair.
If Dave, nickname of Cap (Captain America) could go forth with the surgery, so could you. Now get 'er done. Wishing you a speedy recovery.
UPDATE (7-19-14): It's been exactly one year since Dave had his knee replaced. So far, so good. He's had zero complications. He's actually considering having his other knee replaced soon. Total Knee Replacement surgery is now being done as an Outpatient procedure by some surgeons. This depends on the patient, their living situation, their overall health and who their surgeon is. Depending on the pain medication given and how quickly the patient adapts to their new bionic knee they could only spend one or if needed, two nights in the hospital. All patients and surgeries are different. Just ask.
Team Cap! Dave and Dr. Carlos Alemany (oncologist)
Have my tips calmed fears you might have had for knee replacement surgery?
Team Cap! Cap & Coach Sunshine
Post Surgery Updates
Day #5 The edema in Cap's feet is gone. He, along with assistance from his coach took his first post-surgery shower using the bedside commode for stability. He still has manageable pain and is taking Percocet every 6 hours. His knee bend is at 100* on the CPM.
Day #6 CPM Knee Bend is 105*
One week ago Dave had his Total Knee Replacement. We were supposed to have the traveling nurse here this morning, but wires were crossed. So instead of the nurse removing Cap's dressing from the surgical site, Coach Sunshine did. His scar looks amazing! We are both in awe of the talents of Dr Sean McFadden.
We then went to the hospital for labs. His hemoglobin is 9.1, it was 8.6 when we were discharged. This is good news. His platelets are 170 and Hematocrit is at 28. It's hard to believe it's only been a week since surgery, but so far, so good! We also visited with some of the team from the Orthopedic Floor at Florida East. They were all pleased with his ongoing progress.
Day #10 Knee Bend is 110* on the CPM. Way to go Cap! Knee swelling is beginning to subside.
Day #11 First post-op visit with Dr. McFadden and Dr. Clay. All went well. Xrays were taken. Dr. McFadden is pleased with Cap's progress. He has 2 more weeks of Home Therapy and then 8 weeks of Outpatient Therapy. We shared a few laughs and we once again thanked Team Cap for a job well done.
Day #14 CPM Knee Bend is at 120. Pain is minimal and manageable with Percocet taken as needed.
Day #19 Cap has traded in his walker for a cane. He took a walk outdoors and was tempted to jump for joy, but he refrained :)
Day #21 Outpatient Physical Therapy has begun. Knee Bend is 118*. Minimal pain. All's well in the world of Cap's Total Knee Replacement.
Update Sept. 10 - Dave has graduated from outpatient physical therapy after 5 weeks, which is earlier than most patients. Cap is in excellent shape with a 135* bend and his knee is flat to the surface while laying down, at 0%. Between outpatient therapy twice a week and working out at home every day (I don't believe in a day off from exercise) he has healed well and is now walking...at a leisurely pace. No running yet.
Dave also received clearance from Dr. Sean McFadden, his surgeon. People continue to marvel at the site of Cap's knee surgery. The scar is minimal. In my opinion it's flawless. Kudos to the best orthopedic surgeon at Florida Hospital East Orlando (and Central Florida).
We also learned that patients who have joint replacement surgery are at risk for developing infections of the implanted joints. Due to this, pre-meds are needed before a dental cleaning or any dental work for at least two years. Be sure and mention this to your dentist. Once bacteria that has traveled through the bloodstream find implanted joints, the body's immune system has a difficult time fighting the infection.
I am proud and impressed with Team Cap. I hope that everyone who requires a total knee replacement has the type of team that Cap had.
One day at a time...
Post-Op Xrays reveal Bionic Knee is a perfect match for Cap!
Post Total Knee Replacement Exercise March
Florida Hospital Orthopaedic Institute Reunion
Florida Hospital Orthopaedic Institute — Total Joint Reunion
On February 28th, 2014, we were both invited to a reunion luncheon. We had a great time. Both Dave and I met other patients who had joints replaced.
We met a woman who had both knees replaced at the same time, she's an exception. We also met a woman who had only a partial knee replacement. Among many others.
We also met patients who had no coaches to assist them during their journey. Which made me think, if you know someone who is about to embark on a total joint journey, please reach out to them. Your help will be appreciated, more than you might ever know.
The conference center was filled with excitement. When the guests weren't chattering and laughing away, we were eating our delicious, catered lunch or taking photos in the photo booth.
Our entertainment was by the Royalettes, women who were aged 60-80 and really know how to move!
We heard speeches from the physicians and staff. We listened to stories on the progress on their new bionic knees and hips.
Florida Hospital did not have to host this luncheon. They chose to do so. It would be nice if all, or at least most, medical establishments took the time to appreciate their patients. That's something for other physicians to think about.
Photo Booth Picture
The Royalette Dancers...
Heaven has gained another angel...
July 6, 2015 — My husband, Dave, peacefully passed away. He will be missed. Dave was an inspiration to many. His knee replacement allowed him to walk pain-free during his last two years on earth. Team Cap is now on separate journeys. I continue to advocate against cancer and Dave's body was donated to research to help others. I am so proud of the man who assisted in empowering me while he was fighting for his life. RIP, Cap.
Questions & Answers
© 2013 Linda Bilyeu