Pre-Op and Post-Op Guidelines for Knee Surgery

Proper preparation and planning for your knee operative procedure will help you to achieve a smooth surgical outcome and easier recovery.

Pre-Operative Guidelines

Once a decision is agreed upon between you and A/Prof Woodgate that surgery is the best solution to manage your knee pain and to restore movement and function, a full and open discussion will be undertaken to ensure that you are clear about the nature of the procedure, benefits, risks, long-term outcomes, and likely recovery period.

A/Prof Woodgate feels that it is very important that you voice any concerns or speak up if you do not understand things about the impending treatment programme. On occasions, this may require separate consultations prior to the planned surgery to enable clarification of matters that you may find difficult to understand. Being a surgical patient is difficult at the best of times as you are surrendering control, and many patients find this difficult, and therefore appropriate time will be provided to answer questions and allay concerns. This will include discussion of anaesthetic recommendations and post-operative pain management protocols.

Particular areas to consider in your pre-operative planning include:

Prepare a careful list of your personal information, full medical and surgical history, and include a complete list of medications that you take (both prescription and over-the-counter non-prescription medication, including herbal and naturopathic medications). A number of these herbal medications may interfere with the procedure due to causing excessive bleeding you may be advised when to stop these prior to surgery, in particular fish oil, krill and turmeric. Obviously some prescribed blood thinners and anticoagulant drugs may need to be stopped or changed, and you will be instructed on relevant timing and cessation.
A/Prof Woodgate does not routinely stop Aspirin or anti-inflammatory drugs prior to surgery (there is some strong data to show stopping these in the week prior to hip surgery actually increases the risk of deep venous thrombosis events).
Any allergies or adverse reactions you have had to drugs or anaesthesia in the past. Provide the name of the drug, why you were taking it, a description of your reaction and when it occurred.
If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery.
A consult with a specialist physician may be needed to advise on particular potential health conditions that may cause complications during and after surgery, as well as advice on peri-operative medication reduction or withdrawal.
A strengthening programme before surgery may be recommended (prehab), which includes exercises to improve your strength and flexibility prior to surgery in order to help you in your post-operative recovery. Strengthening your upper body will make it easier to use crutches or a walker after surgery.
If you are planning to have any dental work done, such as an extraction or periodontal treatment, schedule it well in advance of your surgery. Due to the risk of infection, do not schedule any dental work, including routine cleanings, for several weeks (ideally at least 3 months) after your surgery, and even then prophylactic antibiotic cover should be used to decrease the risks of infection spreading to your knee replacement.

Plan for Your Homecoming

Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take prior to the procedure to make your time at home safer and more comfortable:

Borrow a walker or pair of crutches to see how well you can manoeuvre through your home. You may need to rearrange furniture or temporarily change rooms (make the living room your bedroom temporarily).
Remove any throw or area rugs that could cause you to slip or trip. Securely fasten electrical cords around the perimeter of the room.
Place items that you use frequently (such as phone, remote control, radio, facial tissues, wastebasket, reading material and medications) within easy reach so that you do not have to reach up or bend down.
Un-tuck your bedding so that it is easier to move in and out of bed. Also the tight bedding can put undue force on the knee that can cause a pain and swelling.
Arrange for someone to drive you home from the hospital and stay with you for several days after your surgery.
If you do the cooking, make double batches of everything for a week or two before your surgery. Freeze half, and you'll have two weeks of ready-made meals when you get home. If you do not cook, stock up on ready-made foods that can be easily reheated.
Shop for things that will make your life easier after surgery. Helpful items include a long-handled shoehorn, a long-handled sponge, a grabbing tool or reacher, a footstool, and a big-pocket shirt or soft shoulder bag for carrying things around.
If you live alone or have special needs, consider going to a specialized inpatient rehabilitation facility after discharge from the surgical hospital. A/Prof Woodgate can suggest appropriate places to consider that would be appropriate for your initial recovery phase.

Post-Operative Guidelines

After your surgery, you will be shifted to the recovery room where your vitals signs will be monitored. An X-ray will be set a baseline for the implantation of the prosthesis and to confirm there have been no unexpected intra-operative issues. Once you are in a stable condition, you will be transferred back to the ward. Any drain will be removed on day one post surgery. A local anaesthetic device (Painbuster) will typically be removed on day 2 once it is complete. The ward physiotherapist will help you mobilise on the second post-operative day, as well as teach you certain post-operative knee exercises. You will be discharged around 5 to 7 days after the surgery. Prior to discharge, a venous Duplex (ultrasound) scan of the veins in your lower leg will be arranged to exclude deep venous thrombosis (DVT) formation, which would necessitate modification of the ongoing anticoagulation treatment. Long compression TED (Thromboembolic device) stockings are worn for 6 weeks post procedure. In addition, whilst in hospital, a sequential calf compressor device will be attached to “pump” the calf muscles, also to decrease the risk of clots.

During the first few weeks at home, you should take care of your operated knee. Regular ice should be used to decrease swelling. Frequent short walks and home exercises are imperative to progress the recovery programme. It may be necessary helpful to have some assistance or aid while walking.

If you do have a period of organised formal inpatient rehab, this will naturally progress to outpatient treatment 2-3 times per week, depending on progress.

Post-operative review to assess progress is important to ensure optimal outcome following surgery, and follow-up appointments will be required.