How long do I stay in the hospital?
Average length of stay is three nights.
How long do I wear the TED stockings?
You wear them on BOTH legs until your first follow-up appointment when skin staples are removed (approximately 2 weeks post-op), then on the operative limb for one more month.
Who makes arrangements for a physical therapist and/or a nurse to come to my home?
The discharge planners at the hospital make all the arrangements and also resolve insurance issues.
How will my pain be managed?
We now use local anesthesia (previous routine was femoral nerve blocks) to reduce post-op pain.
Clonidine (80 mcg), Ketorolac (30 mg), Epinepherine (500 mcg), Ropivacine (246 mg), 0.9% Sodium Chloride 100 ML. As a result, less narcotic pain relievers are required and constipation is less likely to occur. In addition, non-narcotic toradol is given through the IV for the first 2-3 days unless you have experienced gastric disease or GERD within the last year. Either morphine or hydromorphone is given via intramuscular injection or IV. Oral pain medications include Percocet or Lortab. At time of discharge from the hospital, a prescription for oral pain medication is provided. Patients should be off narcotic pain medication approximately 6 weeks after surgery.
When can I return to work?
You may return on a part-time basis as quickly as 3 weeks after surgery for light, office work. Full time work would typically begin approximately 6 weeks post op. For more labor intensive jobs requiring heavy lifting, climbing ladders, walking on uneven ground, etc, average return to full work duty is 10-12 weeks post op.
How will my blood thinners be managed?
We now often rely on low-dose aspirin instead of Coumadin for anticoagulation. Low-dose aspirin starts the day after surgery and does not require blood tests once you leave the hospital. Patients not appropriate for low-dose aspirin will begin Coumadin the night before surgery and daily thereafter for 2 weeks after discharge from the hospital. While in the hospital, blood tests will be taken daily to monitor Coumadin’s effectiveness with daily adjustments in dose. We will arrange to have a nurse come to your location to draw blood 1-2 times per week for 2 weeks. Once Coumadin is discontinued, 1 adult over-the-counter aspirin (325mg) should be taken daily for 1 month.
What signs or symptoms should I be concerned about?
You should notify us (435-655-6600) if you develop flu-like systems (fever, chills, body aches), increasing redness, heat and swelling, and/or calf pain.
Am I a candidate for having both knees replaced at the same time?
Candidates for bilateral knee replacements should meet the following criteria:
- No major diseases (i.e. heart disease, diabetes, obesity, etc.)
- Aggressive rehab
- Above average pain tolerance
Am I a candidate to go to a rehab facility?
There are certain criteria that must be met for insurance to cover the cost of a rehab unit. Determination is based on how you perform as an inpatient. Typically by post-op day #2, arrangements can be made by a hospital discharge planner if criteria are met based on physical therapy progression.
What are the important risks?
- Infection – the chances of an infection is very low at 0.1% (1 in 1,000 patients). The risk is minimized by IV antibiotic administration before and after surgery and by healthy nutrition pre-op.
- Blood clots – the chance of getting a blood clot is also low at 1%-2%. The risk is minimized by wearing TED stockings, taking blood thinners, using the motion device (CPM), and being active with ambulation starting the day of surgery.
- Incomplete range of motion recovery – 5% risk minimized by CPM machine, physical therapy, and cryo-therapy.
How long do I use the CPM device?
Insurance covers use of the device for 3 weeks from the date of surgery. We recommend using the machine 8-10 hours per day. Some people prefer to sleep with the device on. Advance the motion to 120 degrees of flexion by the time you come in to have your skin staples removed.
When can I fly?
Long-haul flights are not recommended for 3 months due to increased blood clot risk. Out-of-state patients may return home as early as 2 weeks after surgery by learning precautions to reduce the risk of clots: (1) take blood thinners, (2) walk the aisle of the plane every hour, (3) avoid prolonged sitting with the knees bent, (4) perform quad/hamstring muscle contractions and ankle pumps frequently while seated, (5) wear TED stockings and (6) perform deep breathing.
When can I shower?
A waterproof dressing is applied on the day of discharge and will remain intact for 7 days. After 7 days, a new waterproof dressing (which has been provided by the hospital). It is okay to shower once this dressing is in place. Do not allow water to get under your dressing. The dressing will be removed on your first follow-up visit in the clinic when skin staples are removed.
When can I drive?
2 to 4 weeks after surgery if you are off narcotic pain medication and not using assistive devices (crutches or walker) to get around.
Do I need antibiotics before dental procedures after my knee replacement?
The first year following surgery, antibiotics are indicated for dental procedures. We recommend amoxicillin or erythromycin one hour before the procedure. Diabetics and patients with compromised immune systems need antibiotics before dental procedures for life. For other invasive medical procedures, you may contact the respective physician.
How do I know if my therapist is achieving desirable results?
Your dedicated therapist should take specific interest in your progress. If you feel therapy is too easy, you are probably right. Aggressive range of motion therapy early should achieve 0 to 120 degrees of motion by 8-12 weeks after surgery.
What is the new knee made of?
Wright Medical Advance knee system components are made of cobalt chromium molybdenum (femur), and titanium (tibial baseplate). Stryker Triathalon knee system components are made of cobalt chromium molybdenum (both femur and tibia) with hydroxyapatite coating. Stryker has recently introduced titanium mesh base plates as well. See Implant Technology for more information.