Your New Knee - Capital Health
2012
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Capital Health, Nova Scotia
www.cdha.nshealth.ca
Images and text by: Special thanks to Hamilton Health Sciences, Hamilton, Ontario, for permission to use information from “Your New Knee”.
Prepared by: Orthopaedic Health Care Team
We would like to thank our Orthopaedic Health Care Team at the Queen Elizabeth Health Sciences Centre (QEII), Capital Health, Halifax, Nova Scotia,
who provided us with comments and suggestions.
Designed and Printed by: Capital Health Audio Visual and Printing Departments
The information in this brochure is provided for information and education purposes only.
The information is not intended to be and does not constitute healthcare or medical advice.
If you have any questions, please ask your healthcare provider.
WE85-1223 Revised Sept. 2012
The information in this pamphlet is to be updated every 3 years.
Please visit our website:
www.cdha.nshealth.ca
Your New Knee
This patient pathway shows the usual plan of care for most patients. The plan may be changed to meet your needs. April 2009
• Fluids/food as you are able.
• You will get pills for pain if
needed.
• You should be walking
independently with a walking
aid when the physiotherapist
says you are ready.
• You will practice on stairs with
the physiotherapist if needed.
• You will learn about a home
exercise program.
• Your wound will be checked
by the nurse before you go
home.
• You will get medicine everyday
to help prevent blood clots
from forming. You will learn
how to give yourself this
medicine before you go home.
• Your travel plans should be
complete.
• You will go home with all
needed follow-up instructions
and a return appointment
with your surgeon.
• Fluids/food as you are able.
• You will get pills for pain
medicine.
• You will walk farther and with
less help.
• You will be up in a chair for all
of your meals and walking to
the bathroom.
• You will continue to practice
your daily exercises.
• Your wound will be checked
daily.
• You will get medicine
everyday to help prevent
blood clots from forming.
• You will learn more about
activities to avoid when you
first go home.
• Your plans for home will be in
place.
• Fluids/food as you are able.
• You will be given pain
medicine by needle or pill.
You will need to ask your
nurse for this medicine.
• You will start exercises with
the physiotherapist. You will
start walking with a walker.
You should sit in a chair for
all of your meals if you are
able.
• You will practice deep
breathing and coughing &
foot and ankle exercises.
• Your IV may be removed.
• Your wound will be checked
daily.
• You will get medicine
everyday to help prevent
blood clots from forming.
• Your oxygen will be stopped.
• Health care team members
will review your home
arrangements for discharge.
• You will have no
food or drink before
surgery.
• You will wake-up in
the Recovery Room.
• You will return to your
room with an IV and
maybe oxygen.
• You will get pain
medicine by a needle
so that you are
comfortable. You will
need to ask your nurse
for this medicine.
• You will get antibiotics
through the IV to help
prevent infection.
• You will get out of
bed with the help of a
physiotherapist and/or
nurse.
Day 3 to 4 After Surgery
Day 2 After Surgery
Day 1 After Surgery
TOTAL HIP & KNEE REPLACEMENT SURGERY – PATIENT PLAN OF CARE
Day of Surgery
28
Your New Knee
Table of contents
Topic
Page
Introduction............................................................................................................................. 2
Learning about knee replacement surgery................................................................................ 4
Getting ready for surgery.......................................................................................................... 6
Pre-admission clinic visit........................................................................................................... 7
Day of surgery.......................................................................................................................... 9
After surgery - in hospital . ..................................................................................................... 10
Knee rules............................................................................................................................... 13
Exercises................................................................................................................................. 14
How to move ....................................................................................................................... 17
Walking.................................................................................................................................. 18
Stairs...................................................................................................................................... 19
Follow up............................................................................................................................... 21
What to watch for following surgery....................................................................................... 21
Bathing ................................................................................................................................. 22
Driving................................................................................................................................... 23
Preparing your home.............................................................................................................. 24
Health Care Team Members.................................................................................................... 26
Additional appointments........................................................................................................ 27
1
Introduction
Additional appointments
_____________________________________________________________________________________
You are going to have knee replacement surgery. This booklet gives information that will help
you prepare for this surgery and your new knee.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please bring this booklet with you to all of
your appointments, classes and to the hospital.
Please have someone come with you too.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Why do I need a knee replacement?
You may need a knee replacement to:
• lessen your pain
• improve the function of your knee and your ability to do activities
• make your knee more stable
Your surgeon will tell you why you need a knee replacement.
_____________________________________________________________________________________
Questions
_____________________________________________________________________________________
_____________________________________________________________________________________
Orthopaedic Assessment Clinic (OAC) at QEII
The clinic offers a way for the surgeons along with the team to work together to reduce waitlists
and wait times for orthopaedic care. At the clinic, health assessments will be completed by a
case manager, orthopaedic surgeon and other members of the health care team. A care plan will
be developed to address your health needs and readiness for surgery.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Dartmouth General Hospital
If your surgeon is at Dartmouth General Hospital, you will meet with them in their office.
_____________________________________________________________________________________
_____________________________________________________________________________________
Health care team
_____________________________________________________________________________________
You will work closely with your health care team. They are here to support and guide you before,
during and after your knee replacement.
_____________________________________________________________________________________
At the end of this booklet there is a place to add their names as you meet them.
_____________________________________________________________________________________
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27
Health care team members
What to expect
After you see your surgeon:
Surgeon/Resident/Clinical Associate
_____________________________________________
Case Manager
_____________________________________________
Charge Nurse
_____________________________________________
Registered Nurse/Licensed Practical Nurse
_____________________________________________
Physiotherapist
_____________________________________________
Physiotherapy Assistant
_____________________________________________
Occupational Therapist
_____________________________________________
Occupational Therapy Assistant
_____________________________________________
Social Worker
_____________________________________________
Dietitian
_____________________________________________
Dental Work or Other Surgery After Knee Replacement Surgery
Spiritual Care
_____________________________________________
Tell your dentist or other doctors that you have had knee replacement surgery. You may need to
take medication before some procedures to prevent an infection in your knee.
Home Care Nova Scotia Coordinator
_____________________________________________
Unit Clerk
_____________________________________________
Unit Aide
_____________________________________________.
26
✓ You must attend the Pre-Admission Clinic at the Halifax Infirmary or Dartmouth General
Hospital. This visit is usually 2 to 4 weeks before surgery.
✓ You may be referred to an exercise and education program based on your needs. This may
take place months before your surgery.
✓ You may attend a knee education class at the Halifax Infirmary or Dartmouth General
Hospital to learn about your surgery, hospital stay, and going home. The class may be several
weeks or months before surgery. You will be contacted by phone for the class sessions.
Health concerns
If you have health concerns such as diabetes, heart or lung problems, contact your family doctor
or specialists and let them know that you are having knee surgery.
Research
During your hospital stay or clinic visit, you may be asked to take part in a research study. The
research will be explained to you. You can decide whether or not you want to take part. If you
decide not to take part, your care will not be affected.
3
Learning about Knee Replacement Surgery
Kitchen
You may find having a stool or chair with arms useful in the kitchen when preparing meals, if
space allows.
It is helpful to know how the knee works to prepare yourself for surgery.
There are many options in the grocery store for easy to prepare meals. Another option is to
prepare and freeze items before your surgery. Stock up on canned, boxed and freezer food so
you do not have to go to the store right away after your surgery.
How does the knee joint work?
Before surgery, organize your cupboards and fridge so things you need are easy to reach.
The knee joint works like a hinge. The femur (thigh bone) in your upper leg is hinged to the tibia
(shin bone) in your lower leg. The knee joint lets the tibia move back and forth on the femur to
bend and straighten your knee.
Bathroom
Attach a hose or install a removable shower head for easy bathing.
Femur.
(thigh bone)
Put a non-slip mat inside and outside the tub or shower.
If you have difficulty getting on-off a toilet or in-out of bathtub prior to discharge from hospital,
your multidisciplinary team will refer you to occupational therapy. You may need to be assessed
for equipment to help with these tasks.
Cartilage
Patella
(knee cap)
Ligament
Useful website: mysurgery.nshealth.ca Tibia
(shin bone)
Fibula
3 things help the knee joint work easily and without pain:
• the smooth coating over the bones called cartilage
• the slippery fluid inside the joint called synovial fluid
• the muscles and ligaments which support and move the knee.
3 things make the knee painful and hard to move:
• the smooth coating over the bones gets rough and worn away
• the muscles weaken
• the slippery synovial fluid in the knee begins to dry up.
4
25
What is a Knee Replacement?
Work and relaxation
Your therapist can talk to you about limitations and safety during work and relaxation time. Everyone has a different lifestyle. You should increase your activities gradually. Ask your doctor or
therapist to help you plan your return to work and activities.
Prevent knee pain or injury by:
1.Doing your exercises.
2.Using the right equipment.
3.Changing your position often.
4.Stop doing an activity if you have severe pain.
Your surgeon removes the old knee joint and puts in a new joint. This is called a knee
replacement or arthroplasty. Your new knee joint is made of metal and plastic. These new parts
make the knee joint smooth again. There are 2 types of knee replacements:
1. Total knee replacement – All the damaged bone and cartilage on the femur and the tibia
are replaced.
2. Partial Knee Replacement (unicompartmental) – Some people only need part of the knee
joint replaced. If only one side of the femur and tibia are damaged your surgeon may do a
partial knee replacement. This is also referred to as unicondylar or unicompartmental.
Your surgeon will tell you what type of knee replacement you need.
Sexual activity
There are no restrictions regarding sexual activity after knee surgery. Positions where you are
kneeling on your operated leg will not be comfortable.
Femur.
(thigh bone)
Metal
Preparing your home
Patella
(knee cap)
Metal
Plastic
Remove scattermats and extra furniture to
create clear pathways.
Cement
If you need to use stairs, you will need a
handrail. If you do not have a handrail, you will
need to install one.
Tibia
(shin bone)
You will need someone at home with you to help you for at least the first 48-72
hours.
Fibula
How is my new knee attached?
• A cemented replacement uses a special cement or glue to hold the new parts in place.
• A non-cemented type has a coating (rough or smooth) to help the bone grow into the new
replacement parts and hold it in place.
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5
Getting Ready for Surgery
It is helpful to plan ahead. Research shows that people manage their surgery and recovery better
when prepared. If you are having difficulty getting into the tub/shower or reaching your feet after surgery, your
multidisciplinary team may refer you to occupational therapy.
Bedroom
A standard or regular bed with a firm mattress is best.
It is a good idea to have a place to rest during the day on the level you are doing your daytime
activity.
Blood management program
The purpose of the program is:
• to reduce and/or remove the need for blood transfusion during planned surgery
• to educate patients about the risks and benefits of blood transfusions and other blood
alternatives.
You may want to move a bed to the ground floor so you will not have to climb stairs the first
week or two that you are home. If you do need to use the stairs, try to limit the number of times
by organizing yourself and having the things you need close at hand. Organize the dresser
drawers and closet so things are within easy reach. Patients who undergo knee replacement surgery may or may not require a blood transfusion.
More information will be provided in the Pre-Admission Clinic/surgeon’s office regarding this
program.
Help at Home
You may require assistance with tasks such as meal preparation, cleaning and some aspects of
personal care following your surgery.
If you live on your own, arrange to have someone stay with you or stay with someone after
discharge for at least 48-72 hours or until you feel safe to stay alone.
Getting into shape before surgery
Driving
Do not drive until your surgeon tells you that you are ready. If you choose to drive before the
surgeon gives you the okay, you may not be covered by your insurance. Remember to move
your knee and leg often while riding in a car. Try to avoid long rides at first, or at least stop
often for stretch breaks; for example every hour.
Please talk with your occupational therapist if you have any concerns about
getting into your vehicle.
Getting in shape before surgery helps your recovery after surgery. To help you get in shape, you
may be referred to an exercise program in the community or at the hospital.
Depending on your needs, the therapists will give you information about:
✓ an exercise program
✓ your equipment needs
✓ how to prepare your home.
6
23
Physiotherapy
Knee education class
Most patients are walking with a walker before they go home and are able to climb stairs safely. Your therapist will review your mobility equipment needs with you before you go home. You will
need to have this equipment at home before you leave the hospital.
The class takes about 2 hours. The class at the Halifax Infirmary is held at the Orthopaedic
Assessment Clinic. At the Dartmouth General the class is held on the same day as your preadmission clinic visit.
You will need physiotherapy after you go home. Your therapist will talk to you about options:
outpatient clinic at the hospital vs private clinic.
In this class you will learn about:
• your surgery, hospital stay and managing at home home.
• what items you need to bring to the hospital
Exercises
• different types of pain control
It is important for you to keep doing your exercises at home to strengthen your muscles
and get your knee moving well. The therapist will progress your exercise program to help
improve the strength and range of motion of your knee.
• how to do everyday activities such as bathing, dressing
Walking is an excellent exercise. It is important to bend your knee when you walk. Go for several
walks a day. Gradually increase the distance you walk.
Being active keeps you and your new
knee healthy.
• exercises and how to use a walker or crutches
• equipment needs
• care after discharge from hospital
Please come to class with your questions about your knee replacement.
Bring along a family member or friend so that they can learn how they can support you through
this process.
Pre-Admission Clinic visit
Occupational Therapy
If you cannot put your pants, shoes or socks on independently before you leave the hospital, the
multidisciplinary team may refer you to occupational therapy.
.
This clinic visit may take up to 3 to 4 hours. It is very helpful to bring a family member or friend
to this appointment.
Bring all your medications in the original containers, vitamins, plus herbal or natural
supplements you take at home to this appointment.
Bathing
You may shower 3 or 4 days after your surgery
if your incision is not draining. You will have to
put a new bandage over the wound once the
area is thoroughly dry.
Also bring a list of any known allergies.
During the Pre-Admission Clinic visit you will:
• Have an ECG heart test and blood tests.
• You will have an x ray done that day if your last x-ray was taken more than 6 month ago.
There are a few choices for bathing:
1. Take a sponge bath at the sink.
2. Once you and your therapist feel your balance is adequate, you may go into the shower or
use a bath seat.
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7
Items to bring to the hospital
Follow-up
• This book.
You will see your surgeon 2 to 6 weeks after you leave the hospital. If you have stitches or staples
to close your incision you will need to have them removed 10 to 14 days after surgery. Your
nurse may give you a staple remover to take with you to the family doctor or instructions if you
are to return to your surgeon for removal.
• A denture container and appropriate cases if applicable.
• Personal items such as toothpaste, shampoo and grooming items. Perfumes and scented
items such as scented soaps and deodorants are not allowed as the hospital has a Scent Free
Policy.
• A few outfits to wear during your stay, for example loose stretchy clothing such as jogging
pants and a loose top. Housecoats should have front button or zipper closure and be short
enough to avoid tripping when you walk. You will wear a hospital gown during part of your
hospital stay.
• Pack light-weight, supportive shoes with a non slip sole, like running shoes. Supportive
slippers with a back and a non slip sole are okay. Backless slippers are not allowed. Using
elastic laces or Velcro will make fastening shoes easier.
Once your incision is dry it can be left open to the air. If you have steri strips over your incision
they will fall off on their own. If you need bandage changes for your incision after leaving the
hospital, your nurse will arrange with VON or Continuing Care to send a nurse to your home.
What to watch for following surgery
Infection
Bacteria in your blood can get into your new knee and cause an infection. Any infection must
be treated right away.
Signs of infection are:
Please leave the following at home
✓ increased redness around the incision
• large sums of money
✓ swelling
• credit cards
✓ drainage from the incision
• cell phones
✓ increased pain
• jewelry
✓ fever above 38oC or 100oF
• perfumes and scented items
• toileting equipment, for example raised toilet seat
Blood Clots
Telephone or television
Blood clots sometimes form after surgery. The best way to keep a clot from forming is to keep
active and moving. Any blood clot must be treated right away.
You may wish to order a telephone or TV during your stay. Further information can be given to
you when you are admitted to your room.
Signs of blood clots are:
✓ Pain and redness in the calf area
✓ Chest pain with difficulty breathing
If you have any of these changes, call your
surgeon right away.
8
21
Going down steps with a handrail
1. Face the step with the cane/crutch in the hand away from the handrail.
Day of Surgery
2. Stand close to the edge.
3. Put your other hand on the handrail.
4. Put cane/crutch in the middle of the next lower step followed carefully by the operated leg.
5. Step down with the unoperated leg.
It is very important not to have solid food after midnight the night before your surgery. Please
follow the fluid guidelines you received at the Pre‑Admission Clinic or during your doctor’s
appointment. Take only the medications that you were told to take the morning of your surgery,
with sips of water.
Please follow the instructions given to you by the
Pre-Admission Clinic nurse, or you risk having your
surgery cancelled.
You will register in the Same Day Surgery department on the 5th floor of the Halifax Infirmary. Take the elevator by the Robie Street entrance.
At the Dartmouth General enter at the main entrance and stop at the Admitting Desk in the
front entrance.
A nurse will prepare you for the operating room.
All equipment that you will need will be provided while in the hospital. If you came to the
hospital with a walker, cane, crutches or a wheelchair, please have a family member take
them home. Please arrange for this equipment to be brought back to the hospital on the day
of discharge as the physiotherapist will check your walking aid to ensure that it is the correct
height. You will need the walking aid to get to you vehicle.
Cane and operated leg step down together. Step down with the unoperated leg.
Note: Shaded leg is the operated leg.
When you are first home have someone with you when you do the stairs – that person should
follow close behind you on the way up and should be one step below you on the way down.
Going home – Arrange to be picked up before 11:00 am on
discharge day.
20
9
After Surgery – In Hospital
For stairs, curbs and steps
Your therapist will show you how to climb stairs safely.
Going up steps with a handrail
Your surgery will take about 1 1/2 to 2 1/2 hours.
1. Face the step with cane/crutch in the hand away from the handrail.
After surgery you are taken to the Post-Anesthetic Care Unit (PACU) or recovery room where you
will stay and be closely watched until you are ready to go to the inpatient unit. If you have pain
or feel sick, tell the nurse. 2. Stand close to the step.
If you need closer observation or cardiac (heart) monitoring following surgery you may go to the
Intermediate Care Unit (IMCU) or Intensive Care Unit (ICU) for 24-48 hours or until the doctor
feels that you can go safely to an inpatient bed.
3. Put your other hand on the handrail.
4. Put your weight on the handrail and the cane.
5. Step up with your unoperated leg.
6. Straighten your unoperated leg and bring the cane/crutch and the operated leg up together.
While you are on the inpatient unit
Once you arrive on the inpatient unit, the nurses check your vital signs and affected leg. This
includes your blood pressure, heart rate, breathing rate, temperature, and pulses, sensation and
movement in affected leg and foot.
The nurse will examine your abdomen with a stethoscope, checking for bowel sounds. Once
bowel sounds have returned your diet will be increased appropriately. It is common to start with
ice chips or sips of water for the first few hours following surgery.
Bloodwork is generally done following surgery.
You will be encouraged to do as much for yourself as possible.
Your leg may be bruised and swollen, and painful as you move. The nurses will check your
bandage and ask you about your pain.
Pain control
It is normal to have pain after surgery. A pain scale (where ”0” means no pain and ”10” means
worst pain) will be used. You will be asked to rate your pain using this scale.
Step up with the unoperated leg.
Cane and operated leg step up together.
Note: Shaded leg is the operated leg.
0 —— 1 —— 2 —— 3 —— 4 —— 5 —— 6 —— 7 —— 8 —— 9 —— 10
No Pain Worst Pain
The pain will be controlled with medications. Members of the health care team will help
you with pain relief. The pain will lessen over time as you heal. It is important to have your
pain controlled so that you can do your exercises and move around. Ask the nurse for pain
medications as needed.
10
19
Walking
Confusion
You may be up to a chair or walking on the day
of your surgery. You will use a walker first, and
may progress crutches or a cane. The first few
times you get out of bed, you may feel weak
or dizzy. Make sure a nurse or therapist is with
you. Tell them anytime you feel weak or dizzy.
The physiotherapist will give you feedback to
help make sure you are walking correctly. Your
therapist will tell you when it is safe for you to
walk by yourself.
Some people may become confused from anesthetic, or use of pain medication after surgery. If you have a history of being confused while in the hospital, please tell your surgeon or other
health care provider.
When you are walking with a walker, follow
these steps:
If, as a family member or friend, you notice that your loved one is acting differently or is restless,
please tell the nurse.
Nausea
You may have an upset stomach or nausea after any type of anesthesia. Nausea is also a side
effect of some pain medication. If you feel unwell or have nausea, tell your nurse. You will be
given some medication to help with the symptoms.
1. Move your walker ahead first.
Skin
2. Step forward with your operated leg, followed by the unoperated leg.
Healthy skin helps prevent infections. Your bandages and incision will be checked often while
you are in the hospital.
Take short walks as often as you can using
your walking aid. Walking helps prevent joint
stiffness and is good for your general health,
strength and circulation. Remember to bend
your knee as you are walking.
Lying in bed puts pressure on your skin. Over time you can develop a pressure ulcer. The first
signs of this problem are burning, redness or pain. If you have any of these signs on your
buttocks, ankles, heels, elbows, shoulders or ears, talk to your nurse or therapist.
The best way to avoid skin problems is to change
position. Avoid lying down in bed for long periods
of time. The nurses and therapists will remind
you to get up and move as much as possible after
surgery. You should be getting up and out of bed
for all your meals. You should also remember to do
this when you go home.
Try to increase your distance as you are able.
When turning avoid twisting your knee and
turn towards your good side.
Swelling
It is normal to have some swelling in your operative leg after surgery – this can occur for the
first few weeks after surgery. Swelling may increase as you become more active. To help reduce
the swelling avoid sitting for prolonged periods and pump your ankles and feet to keep the
circulation going.
18
11
How to Move
Weakness
You may feel tired and dizzy when you get out of bed after surgery. Make sure someone helps
you get up until you are safe to move around on your own. Staff will tell you when it is safe for
you to get up to the washroom or to walk by yourself.
Getting in and out of bed
The day of surgery or the first day after surgery, your nurse or therapist will show you the right
way to get in and out of bed.
Urinary problems
You may have trouble urinating or passing water after surgery. If you have any problem passing
urine, are urinating often, or have burning when passing urine, talk with your nurse. If you are
unable to urinate 12 hours following your surgery your nurse will do a urinary catheterization to
empty your bladder.
To get out of bed from a lying position:
• Push up on your elbows and hands.
• Then slide your hips and legs over to the edge of the bed to sit.
• When possible, get in and out of bed by leading with your unoperated leg.
• Sleep on the side of the bed that you are most confortable on.
Bowel problems
There can be a change in your bowel habits after surgery.
Sitting down
Your surgeon may start you on a laxative or stool softener because pain medication can cause
constipation. If you are going home on pain medications, you may need to continue taking a
laxative. You can buy these as an over-the-counter medication at any drug store.
When you sit down, follow these steps:
Remember to drink plenty of liquids, eat foods with natural roughage (fiber) and be as active as
possible.
1. Back up to the edge of the chair or bed.
2. Feel the edge of the chair or bed with the
back of your knees.
3. Slide your operated leg forward.
4. Hold the arm rests or bed with your hands.
Lung problems
After surgery, your activity will be less than normal. Deep breathing and coughing exercises are
important to do every hour while awake. Your nurse may teach you how to use a device called
an incentive spirometer that can help with deep breathing.
Deep breathing and coughing helps to:
5. Lower yourself to sitting position slowly and
gently. Standing up
When you stand up, follow these steps:
• keep your lungs expanding fully
1. Move to the edge of the chair or bed.
• clear mucus from your lungs and throat
• reduce the chance of getting a chest infection.
Getting up and moving around is one of the best activities to help keep your lungs clear.
Blood clots
You have an increased risk of forming a blood clot after surgery. It is very important to do your
exercises and get up and move as much as you can after surgery to prevent blood clots.
Signs of a blood clot in your legs are redness, swelling, warmth or pain anywhere in either leg. 12
2. Bend your unoperated leg under you to hold your body weight.
3. Slide your operated leg forward.
4. Push down with your hands on the chair arms or bed to stand up. Put most of your weight on your unoperated leg.
5. Once you have your balance, use your walking aid.
17
Ice
Ice reduces pain and swelling. You will be given an ice pack every 1-2 hours to use across your
knee. Do not leave the ice pack on for more than 15 minutes at a time. Elevating the leg on
pillows while applying ice will help to reduce the swelling.
Weight bearing
Weight bearing is the amount of weight you can put on your operated leg. Usually after knee
surgery you are allowed to bear weight as tolerated. If you have restrictions in the amount of
weight that you are allowed to put on the operated leg the nurse and physiotherapist will review
how to walk.
Signs of a blood clot in your lung are sharp chest pain, rapid heart rate, blood-tinged sputum,
shortness of breath, or low grade fever. Tell a member of your health care team right away if you
notice any of these signs.
Your surgeon will assess and decide what anti-coagulant or blood thinning medication you will
need. Blood thinning medication can be ordered in pill or needle form. You may need to go
home on blood thinning medications. If the medication is in needle form you will be taught self
injection. Your surgeon may also want you to wear special stockings called TEDS to help reduce
the risk of clots. If you are on medications to prevent blood clots, it is important to complete all
of the medication.
Knee Rules
Follow these rules to help your muscles heal, get strong and work well.
Rule # 1
Resting positions
Move your knee often. Do the exercises your
therapist has taught you.
Rule # 2
Find a position of comfort. Nothing limits you from sidelying however it may not be as
comfortable in the early days after surgery when compared to lying on your back.
For long periods, the best way to lie in bed is on your back.
Try to keep your knees and toes pointing up. Do not put a pillow under your operated knee.
It is ok however to place a pillow lengthwise under your leg to help with swelling as long as the
knee is able to be kept in a straightened position.
Do not use a pillow or support under your
knee. Pillows and supports cause the muscles
and ligaments to shorten, making it difficult
to straighten your knee.
It is OK however to place a pillow lengthwise
under your leg to help with swelling as
long as the knee is able to be kept in a
straightened position.
Rule #3
When lying on your side put 1-2 pillows between your knees for comfort.
If you need to reduce swelling in your leg, you can lie on your back and put a pillow under
your ankle to keep your ankle higher than your knee.
16
You should sit on a chair with arms to make
getting up and down easier. Higher seats will
be easier to get up from than lower ones in
the early days after surgery.
13
Straight leg raise
• Lying on back with leg straight, opposite knee bent.
Exercises
Exercise following surgery will help:
• Tighten thigh muscle.
✓ strengthen the muscles in your legs
• Slowly raise the leg off the bed keeping the knee straight.
✓ move your new knee and prevent joint stiffness
✓ improve blood supply to your legs.
• Hold 20 seconds.
• Repeat 10 times.
Your physiotherapist will instruct you in your exercises.
You are expected to do these exercises daily while in hospital and when you go home. As you
get stronger, your physiotherapist will progress the exercises.
Repeat the exercises below at least 3 times a day.
Do each exercise 10 times.
Knee extension - sitting
•
•
•
•
•
Straighten your leg as far as possible.
Hold for 5 seconds.
Then bring your heel as far back under the chair as possible.
Hold for 5 seconds.
Relax and repeat 10 times.
Leg Exercises - While lying down
Heel slides
• Slide your heel towards your buttocks.
• Keep your heel and buttocks on the bed.
• Hold for 5 seconds.
• Relax and repeat 10 times.
Let Pain be Your Guide!!
Quad Isometrics
• Straighten your leg by tightening the muscles on the front of your thigh.
• Push your knee into the bed.
• Hold for 5 seconds.
• Relax and repeat 10 times.
Quad over roll
• Wrap a large can in a towel. Place under your knee.
• Lift your foot off the bed by straightening your leg.
• DO NOT lift your knee off the can.
• Hold for 5 seconds.
• Relax and repeat 10 times.
14
15
Straight leg raise
• Lying on back with leg straight, opposite knee bent.
Exercises
Exercise following surgery will help:
• Tighten thigh muscle.
✓ strengthen the muscles in your legs
• Slowly raise the leg off the bed keeping the knee straight.
✓ move your new knee and prevent joint stiffness
✓ improve blood supply to your legs.
• Hold 20 seconds.
• Repeat 10 times.
Your physiotherapist will instruct you in your exercises.
You are expected to do these exercises daily while in hospital and when you go home. As you
get stronger, your physiotherapist will progress the exercises.
Repeat the exercises below at least 3 times a day.
Do each exercise 10 times.
Knee extension - sitting
•
•
•
•
•
Straighten your leg as far as possible.
Hold for 5 seconds.
Then bring your heel as far back under the chair as possible.
Hold for 5 seconds.
Relax and repeat 10 times.
Leg Exercises - While lying down
Heel slides
• Slide your heel towards your buttocks.
• Keep your heel and buttocks on the bed.
• Hold for 5 seconds.
• Relax and repeat 10 times.
Let Pain be Your Guide!!
Quad Isometrics
• Straighten your leg by tightening the muscles on the front of your thigh.
• Push your knee into the bed.
• Hold for 5 seconds.
• Relax and repeat 10 times.
Quad over roll
• Wrap a large can in a towel. Place under your knee.
• Lift your foot off the bed by straightening your leg.
• DO NOT lift your knee off the can.
• Hold for 5 seconds.
• Relax and repeat 10 times.
14
15
Ice
Ice reduces pain and swelling. You will be given an ice pack every 1-2 hours to use across your
knee. Do not leave the ice pack on for more than 15 minutes at a time. Elevating the leg on
pillows while applying ice will help to reduce the swelling.
Weight bearing
Weight bearing is the amount of weight you can put on your operated leg. Usually after knee
surgery you are allowed to bear weight as tolerated. If you have restrictions in the amount of
weight that you are allowed to put on the operated leg the nurse and physiotherapist will review
how to walk.
Signs of a blood clot in your lung are sharp chest pain, rapid heart rate, blood-tinged sputum,
shortness of breath, or low grade fever. Tell a member of your health care team right away if you
notice any of these signs.
Your surgeon will assess and decide what anti-coagulant or blood thinning medication you will
need. Blood thinning medication can be ordered in pill or needle form. You may need to go
home on blood thinning medications. If the medication is in needle form you will be taught self
injection. Your surgeon may also want you to wear special stockings called TEDS to help reduce
the risk of clots. If you are on medications to prevent blood clots, it is important to complete all
of the medication.
Knee Rules
Follow these rules to help your muscles heal, get strong and work well.
Rule # 1
Resting positions
Move your knee often. Do the exercises your
therapist has taught you.
Rule # 2
Find a position of comfort. Nothing limits you from sidelying however it may not be as
comfortable in the early days after surgery when compared to lying on your back.
For long periods, the best way to lie in bed is on your back.
Try to keep your knees and toes pointing up. Do not put a pillow under your operated knee.
It is ok however to place a pillow lengthwise under your leg to help with swelling as long as the
knee is able to be kept in a straightened position.
Do not use a pillow or support under your
knee. Pillows and supports cause the muscles
and ligaments to shorten, making it difficult
to straighten your knee.
It is OK however to place a pillow lengthwise
under your leg to help with swelling as
long as the knee is able to be kept in a
straightened position.
Rule #3
When lying on your side put 1-2 pillows between your knees for comfort.
If you need to reduce swelling in your leg, you can lie on your back and put a pillow under
your ankle to keep your ankle higher than your knee.
16
You should sit on a chair with arms to make
getting up and down easier. Higher seats will
be easier to get up from than lower ones in
the early days after surgery.
13
How to Move
Weakness
You may feel tired and dizzy when you get out of bed after surgery. Make sure someone helps
you get up until you are safe to move around on your own. Staff will tell you when it is safe for
you to get up to the washroom or to walk by yourself.
Getting in and out of bed
The day of surgery or the first day after surgery, your nurse or therapist will show you the right
way to get in and out of bed.
Urinary problems
You may have trouble urinating or passing water after surgery. If you have any problem passing
urine, are urinating often, or have burning when passing urine, talk with your nurse. If you are
unable to urinate 12 hours following your surgery your nurse will do a urinary catheterization to
empty your bladder.
To get out of bed from a lying position:
• Push up on your elbows and hands.
• Then slide your hips and legs over to the edge of the bed to sit.
• When possible, get in and out of bed by leading with your unoperated leg.
• Sleep on the side of the bed that you are most confortable on.
Bowel problems
There can be a change in your bowel habits after surgery.
Sitting down
Your surgeon may start you on a laxative or stool softener because pain medication can cause
constipation. If you are going home on pain medications, you may need to continue taking a
laxative. You can buy these as an over-the-counter medication at any drug store.
When you sit down, follow these steps:
Remember to drink plenty of liquids, eat foods with natural roughage (fiber) and be as active as
possible.
1. Back up to the edge of the chair or bed.
2. Feel the edge of the chair or bed with the
back of your knees.
3. Slide your operated leg forward.
4. Hold the arm rests or bed with your hands.
Lung problems
After surgery, your activity will be less than normal. Deep breathing and coughing exercises are
important to do every hour while awake. Your nurse may teach you how to use a device called
an incentive spirometer that can help with deep breathing.
Deep breathing and coughing helps to:
5. Lower yourself to sitting position slowly and
gently. Standing up
When you stand up, follow these steps:
• keep your lungs expanding fully
1. Move to the edge of the chair or bed.
• clear mucus from your lungs and throat
• reduce the chance of getting a chest infection.
Getting up and moving around is one of the best activities to help keep your lungs clear.
Blood clots
You have an increased risk of forming a blood clot after surgery. It is very important to do your
exercises and get up and move as much as you can after surgery to prevent blood clots.
Signs of a blood clot in your legs are redness, swelling, warmth or pain anywhere in either leg. 12
2. Bend your unoperated leg under you to hold your body weight.
3. Slide your operated leg forward.
4. Push down with your hands on the chair arms or bed to stand up. Put most of your weight on your unoperated leg.
5. Once you have your balance, use your walking aid.
17
Walking
Confusion
You may be up to a chair or walking on the day
of your surgery. You will use a walker first, and
may progress crutches or a cane. The first few
times you get out of bed, you may feel weak
or dizzy. Make sure a nurse or therapist is with
you. Tell them anytime you feel weak or dizzy.
The physiotherapist will give you feedback to
help make sure you are walking correctly. Your
therapist will tell you when it is safe for you to
walk by yourself.
Some people may become confused from anesthetic, or use of pain medication after surgery. If you have a history of being confused while in the hospital, please tell your surgeon or other
health care provider.
When you are walking with a walker, follow
these steps:
If, as a family member or friend, you notice that your loved one is acting differently or is restless,
please tell the nurse.
Nausea
You may have an upset stomach or nausea after any type of anesthesia. Nausea is also a side
effect of some pain medication. If you feel unwell or have nausea, tell your nurse. You will be
given some medication to help with the symptoms.
1. Move your walker ahead first.
Skin
2. Step forward with your operated leg, followed by the unoperated leg.
Healthy skin helps prevent infections. Your bandages and incision will be checked often while
you are in the hospital.
Take short walks as often as you can using
your walking aid. Walking helps prevent joint
stiffness and is good for your general health,
strength and circulation. Remember to bend
your knee as you are walking.
Lying in bed puts pressure on your skin. Over time you can develop a pressure ulcer. The first
signs of this problem are burning, redness or pain. If you have any of these signs on your
buttocks, ankles, heels, elbows, shoulders or ears, talk to your nurse or therapist.
The best way to avoid skin problems is to change
position. Avoid lying down in bed for long periods
of time. The nurses and therapists will remind
you to get up and move as much as possible after
surgery. You should be getting up and out of bed
for all your meals. You should also remember to do
this when you go home.
Try to increase your distance as you are able.
When turning avoid twisting your knee and
turn towards your good side.
Swelling
It is normal to have some swelling in your operative leg after surgery – this can occur for the
first few weeks after surgery. Swelling may increase as you become more active. To help reduce
the swelling avoid sitting for prolonged periods and pump your ankles and feet to keep the
circulation going.
18
11
After Surgery – In Hospital
For stairs, curbs and steps
Your therapist will show you how to climb stairs safely.
Going up steps with a handrail
Your surgery will take about 1 1/2 to 2 1/2 hours.
1. Face the step with cane/crutch in the hand away from the handrail.
After surgery you are taken to the Post-Anesthetic Care Unit (PACU) or recovery room where you
will stay and be closely watched until you are ready to go to the inpatient unit. If you have pain
or feel sick, tell the nurse. 2. Stand close to the step.
If you need closer observation or cardiac (heart) monitoring following surgery you may go to the
Intermediate Care Unit (IMCU) or Intensive Care Unit (ICU) for 24-48 hours or until the doctor
feels that you can go safely to an inpatient bed.
3. Put your other hand on the handrail.
4. Put your weight on the handrail and the cane.
5. Step up with your unoperated leg.
6. Straighten your unoperated leg and bring the cane/crutch and the operated leg up together.
While you are on the inpatient unit
Once you arrive on the inpatient unit, the nurses check your vital signs and affected leg. This
includes your blood pressure, heart rate, breathing rate, temperature, and pulses, sensation and
movement in affected leg and foot.
The nurse will examine your abdomen with a stethoscope, checking for bowel sounds. Once
bowel sounds have returned your diet will be increased appropriately. It is common to start with
ice chips or sips of water for the first few hours following surgery.
Bloodwork is generally done following surgery.
You will be encouraged to do as much for yourself as possible.
Your leg may be bruised and swollen, and painful as you move. The nurses will check your
bandage and ask you about your pain.
Pain control
It is normal to have pain after surgery. A pain scale (where ”0” means no pain and ”10” means
worst pain) will be used. You will be asked to rate your pain using this scale.
Step up with the unoperated leg.
Cane and operated leg step up together.
Note: Shaded leg is the operated leg.
0 —— 1 —— 2 —— 3 —— 4 —— 5 —— 6 —— 7 —— 8 —— 9 —— 10
No Pain Worst Pain
The pain will be controlled with medications. Members of the health care team will help
you with pain relief. The pain will lessen over time as you heal. It is important to have your
pain controlled so that you can do your exercises and move around. Ask the nurse for pain
medications as needed.
10
19
Going down steps with a handrail
1. Face the step with the cane/crutch in the hand away from the handrail.
Day of Surgery
2. Stand close to the edge.
3. Put your other hand on the handrail.
4. Put cane/crutch in the middle of the next lower step followed carefully by the operated leg.
5. Step down with the unoperated leg.
It is very important not to have solid food after midnight the night before your surgery. Please
follow the fluid guidelines you received at the Pre‑Admission Clinic or during your doctor’s
appointment. Take only the medications that you were told to take the morning of your surgery,
with sips of water.
Please follow the instructions given to you by the
Pre-Admission Clinic nurse, or you risk having your
surgery cancelled.
You will register in the Same Day Surgery department on the 5th floor of the Halifax Infirmary. Take the elevator by the Robie Street entrance.
At the Dartmouth General enter at the main entrance and stop at the Admitting Desk in the
front entrance.
A nurse will prepare you for the operating room.
All equipment that you will need will be provided while in the hospital. If you came to the
hospital with a walker, cane, crutches or a wheelchair, please have a family member take
them home. Please arrange for this equipment to be brought back to the hospital on the day
of discharge as the physiotherapist will check your walking aid to ensure that it is the correct
height. You will need the walking aid to get to you vehicle.
Cane and operated leg step down together. Step down with the unoperated leg.
Note: Shaded leg is the operated leg.
When you are first home have someone with you when you do the stairs – that person should
follow close behind you on the way up and should be one step below you on the way down.
Going home – Arrange to be picked up before 11:00 am on
discharge day.
20
9
Items to bring to the hospital
Follow-up
• This book.
You will see your surgeon 2 to 6 weeks after you leave the hospital. If you have stitches or staples
to close your incision you will need to have them removed 10 to 14 days after surgery. Your
nurse may give you a staple remover to take with you to the family doctor or instructions if you
are to return to your surgeon for removal.
• A denture container and appropriate cases if applicable.
• Personal items such as toothpaste, shampoo and grooming items. Perfumes and scented
items such as scented soaps and deodorants are not allowed as the hospital has a Scent Free
Policy.
• A few outfits to wear during your stay, for example loose stretchy clothing such as jogging
pants and a loose top. Housecoats should have front button or zipper closure and be short
enough to avoid tripping when you walk. You will wear a hospital gown during part of your
hospital stay.
• Pack light-weight, supportive shoes with a non slip sole, like running shoes. Supportive
slippers with a back and a non slip sole are okay. Backless slippers are not allowed. Using
elastic laces or Velcro will make fastening shoes easier.
Once your incision is dry it can be left open to the air. If you have steri strips over your incision
they will fall off on their own. If you need bandage changes for your incision after leaving the
hospital, your nurse will arrange with VON or Continuing Care to send a nurse to your home.
What to watch for following surgery
Infection
Bacteria in your blood can get into your new knee and cause an infection. Any infection must
be treated right away.
Signs of infection are:
Please leave the following at home
✓ increased redness around the incision
• large sums of money
✓ swelling
• credit cards
✓ drainage from the incision
• cell phones
✓ increased pain
• jewelry
✓ fever above 38oC or 100oF
• perfumes and scented items
• toileting equipment, for example raised toilet seat
Blood Clots
Telephone or television
Blood clots sometimes form after surgery. The best way to keep a clot from forming is to keep
active and moving. Any blood clot must be treated right away.
You may wish to order a telephone or TV during your stay. Further information can be given to
you when you are admitted to your room.
Signs of blood clots are:
✓ Pain and redness in the calf area
✓ Chest pain with difficulty breathing
If you have any of these changes, call your
surgeon right away.
8
21
Physiotherapy
Knee education class
Most patients are walking with a walker before they go home and are able to climb stairs safely. Your therapist will review your mobility equipment needs with you before you go home. You will
need to have this equipment at home before you leave the hospital.
The class takes about 2 hours. The class at the Halifax Infirmary is held at the Orthopaedic
Assessment Clinic. At the Dartmouth General the class is held on the same day as your preadmission clinic visit.
You will need physiotherapy after you go home. Your therapist will talk to you about options:
outpatient clinic at the hospital vs private clinic.
In this class you will learn about:
• your surgery, hospital stay and managing at home home.
• what items you need to bring to the hospital
Exercises
• different types of pain control
It is important for you to keep doing your exercises at home to strengthen your muscles
and get your knee moving well. The therapist will progress your exercise program to help
improve the strength and range of motion of your knee.
• how to do everyday activities such as bathing, dressing
Walking is an excellent exercise. It is important to bend your knee when you walk. Go for several
walks a day. Gradually increase the distance you walk.
Being active keeps you and your new
knee healthy.
• exercises and how to use a walker or crutches
• equipment needs
• care after discharge from hospital
Please come to class with your questions about your knee replacement.
Bring along a family member or friend so that they can learn how they can support you through
this process.
Pre-Admission Clinic visit
Occupational Therapy
If you cannot put your pants, shoes or socks on independently before you leave the hospital, the
multidisciplinary team may refer you to occupational therapy.
.
This clinic visit may take up to 3 to 4 hours. It is very helpful to bring a family member or friend
to this appointment.
Bring all your medications in the original containers, vitamins, plus herbal or natural
supplements you take at home to this appointment.
Bathing
You may shower 3 or 4 days after your surgery
if your incision is not draining. You will have to
put a new bandage over the wound once the
area is thoroughly dry.
Also bring a list of any known allergies.
During the Pre-Admission Clinic visit you will:
• Have an ECG heart test and blood tests.
• You will have an x ray done that day if your last x-ray was taken more than 6 month ago.
There are a few choices for bathing:
1. Take a sponge bath at the sink.
2. Once you and your therapist feel your balance is adequate, you may go into the shower or
use a bath seat.
22
7
Getting Ready for Surgery
It is helpful to plan ahead. Research shows that people manage their surgery and recovery better
when prepared. If you are having difficulty getting into the tub/shower or reaching your feet after surgery, your
multidisciplinary team may refer you to occupational therapy.
Bedroom
A standard or regular bed with a firm mattress is best.
It is a good idea to have a place to rest during the day on the level you are doing your daytime
activity.
Blood management program
The purpose of the program is:
• to reduce and/or remove the need for blood transfusion during planned surgery
• to educate patients about the risks and benefits of blood transfusions and other blood
alternatives.
You may want to move a bed to the ground floor so you will not have to climb stairs the first
week or two that you are home. If you do need to use the stairs, try to limit the number of times
by organizing yourself and having the things you need close at hand. Organize the dresser
drawers and closet so things are within easy reach. Patients who undergo knee replacement surgery may or may not require a blood transfusion.
More information will be provided in the Pre-Admission Clinic/surgeon’s office regarding this
program.
Help at Home
You may require assistance with tasks such as meal preparation, cleaning and some aspects of
personal care following your surgery.
If you live on your own, arrange to have someone stay with you or stay with someone after
discharge for at least 48-72 hours or until you feel safe to stay alone.
Getting into shape before surgery
Driving
Do not drive until your surgeon tells you that you are ready. If you choose to drive before the
surgeon gives you the okay, you may not be covered by your insurance. Remember to move
your knee and leg often while riding in a car. Try to avoid long rides at first, or at least stop
often for stretch breaks; for example every hour.
Please talk with your occupational therapist if you have any concerns about
getting into your vehicle.
Getting in shape before surgery helps your recovery after surgery. To help you get in shape, you
may be referred to an exercise program in the community or at the hospital.
Depending on your needs, the therapists will give you information about:
✓ an exercise program
✓ your equipment needs
✓ how to prepare your home.
6
23
What is a Knee Replacement?
Work and relaxation
Your therapist can talk to you about limitations and safety during work and relaxation time. Everyone has a different lifestyle. You should increase your activities gradually. Ask your doctor or
therapist to help you plan your return to work and activities.
Prevent knee pain or injury by:
1.Doing your exercises.
2.Using the right equipment.
3.Changing your position often.
4.Stop doing an activity if you have severe pain.
Your surgeon removes the old knee joint and puts in a new joint. This is called a knee
replacement or arthroplasty. Your new knee joint is made of metal and plastic. These new parts
make the knee joint smooth again. There are 2 types of knee replacements:
1. Total knee replacement – All the damaged bone and cartilage on the femur and the tibia
are replaced.
2. Partial Knee Replacement (unicompartmental) – Some people only need part of the knee
joint replaced. If only one side of the femur and tibia are damaged your surgeon may do a
partial knee replacement. This is also referred to as unicondylar or unicompartmental.
Your surgeon will tell you what type of knee replacement you need.
Sexual activity
There are no restrictions regarding sexual activity after knee surgery. Positions where you are
kneeling on your operated leg will not be comfortable.
Femur.
(thigh bone)
Metal
Preparing your home
Patella
(knee cap)
Metal
Plastic
Remove scattermats and extra furniture to
create clear pathways.
Cement
If you need to use stairs, you will need a
handrail. If you do not have a handrail, you will
need to install one.
Tibia
(shin bone)
You will need someone at home with you to help you for at least the first 48-72
hours.
Fibula
How is my new knee attached?
• A cemented replacement uses a special cement or glue to hold the new parts in place.
• A non-cemented type has a coating (rough or smooth) to help the bone grow into the new
replacement parts and hold it in place.
24
5
Learning about Knee Replacement Surgery
Kitchen
You may find having a stool or chair with arms useful in the kitchen when preparing meals, if
space allows.
It is helpful to know how the knee works to prepare yourself for surgery.
There are many options in the grocery store for easy to prepare meals. Another option is to
prepare and freeze items before your surgery. Stock up on canned, boxed and freezer food so
you do not have to go to the store right away after your surgery.
How does the knee joint work?
Before surgery, organize your cupboards and fridge so things you need are easy to reach.
The knee joint works like a hinge. The femur (thigh bone) in your upper leg is hinged to the tibia
(shin bone) in your lower leg. The knee joint lets the tibia move back and forth on the femur to
bend and straighten your knee.
Bathroom
Attach a hose or install a removable shower head for easy bathing.
Femur.
(thigh bone)
Put a non-slip mat inside and outside the tub or shower.
If you have difficulty getting on-off a toilet or in-out of bathtub prior to discharge from hospital,
your multidisciplinary team will refer you to occupational therapy. You may need to be assessed
for equipment to help with these tasks.
Cartilage
Patella
(knee cap)
Ligament
Useful website: mysurgery.nshealth.ca Tibia
(shin bone)
Fibula
3 things help the knee joint work easily and without pain:
• the smooth coating over the bones called cartilage
• the slippery fluid inside the joint called synovial fluid
• the muscles and ligaments which support and move the knee.
3 things make the knee painful and hard to move:
• the smooth coating over the bones gets rough and worn away
• the muscles weaken
• the slippery synovial fluid in the knee begins to dry up.
4
25
Health care team members
What to expect
After you see your surgeon:
Surgeon/Resident/Clinical Associate
_____________________________________________
Case Manager
_____________________________________________
Charge Nurse
_____________________________________________
Registered Nurse/Licensed Practical Nurse
_____________________________________________
Physiotherapist
_____________________________________________
Physiotherapy Assistant
_____________________________________________
Occupational Therapist
_____________________________________________
Occupational Therapy Assistant
_____________________________________________
Social Worker
_____________________________________________
Dietitian
_____________________________________________
Dental Work or Other Surgery After Knee Replacement Surgery
Spiritual Care
_____________________________________________
Tell your dentist or other doctors that you have had knee replacement surgery. You may need to
take medication before some procedures to prevent an infection in your knee.
Home Care Nova Scotia Coordinator
_____________________________________________
Unit Clerk
_____________________________________________
Unit Aide
_____________________________________________.
26
✓ You must attend the Pre-Admission Clinic at the Halifax Infirmary or Dartmouth General
Hospital. This visit is usually 2 to 4 weeks before surgery.
✓ You may be referred to an exercise and education program based on your needs. This may
take place months before your surgery.
✓ You may attend a knee education class at the Halifax Infirmary or Dartmouth General
Hospital to learn about your surgery, hospital stay, and going home. The class may be several
weeks or months before surgery. You will be contacted by phone for the class sessions.
Health concerns
If you have health concerns such as diabetes, heart or lung problems, contact your family doctor
or specialists and let them know that you are having knee surgery.
Research
During your hospital stay or clinic visit, you may be asked to take part in a research study. The
research will be explained to you. You can decide whether or not you want to take part. If you
decide not to take part, your care will not be affected.
3
Introduction
Additional appointments
_____________________________________________________________________________________
You are going to have knee replacement surgery. This booklet gives information that will help
you prepare for this surgery and your new knee.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please bring this booklet with you to all of
your appointments, classes and to the hospital.
Please have someone come with you too.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Why do I need a knee replacement?
You may need a knee replacement to:
• lessen your pain
• improve the function of your knee and your ability to do activities
• make your knee more stable
Your surgeon will tell you why you need a knee replacement.
_____________________________________________________________________________________
Questions
_____________________________________________________________________________________
_____________________________________________________________________________________
Orthopaedic Assessment Clinic (OAC) at QEII
The clinic offers a way for the surgeons along with the team to work together to reduce waitlists
and wait times for orthopaedic care. At the clinic, health assessments will be completed by a
case manager, orthopaedic surgeon and other members of the health care team. A care plan will
be developed to address your health needs and readiness for surgery.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Dartmouth General Hospital
If your surgeon is at Dartmouth General Hospital, you will meet with them in their office.
_____________________________________________________________________________________
_____________________________________________________________________________________
Health care team
_____________________________________________________________________________________
You will work closely with your health care team. They are here to support and guide you before,
during and after your knee replacement.
_____________________________________________________________________________________
At the end of this booklet there is a place to add their names as you meet them.
_____________________________________________________________________________________
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27
This patient pathway shows the usual plan of care for most patients. The plan may be changed to meet your needs. April 2009
• Fluids/food as you are able.
• You will get pills for pain if
needed.
• You should be walking
independently with a walking
aid when the physiotherapist
says you are ready.
• You will practice on stairs with
the physiotherapist if needed.
• You will learn about a home
exercise program.
• Your wound will be checked
by the nurse before you go
home.
• You will get medicine everyday
to help prevent blood clots
from forming. You will learn
how to give yourself this
medicine before you go home.
• Your travel plans should be
complete.
• You will go home with all
needed follow-up instructions
and a return appointment
with your surgeon.
• Fluids/food as you are able.
• You will get pills for pain
medicine.
• You will walk farther and with
less help.
• You will be up in a chair for all
of your meals and walking to
the bathroom.
• You will continue to practice
your daily exercises.
• Your wound will be checked
daily.
• You will get medicine
everyday to help prevent
blood clots from forming.
• You will learn more about
activities to avoid when you
first go home.
• Your plans for home will be in
place.
• Fluids/food as you are able.
• You will be given pain
medicine by needle or pill.
You will need to ask your
nurse for this medicine.
• You will start exercises with
the physiotherapist. You will
start walking with a walker.
You should sit in a chair for
all of your meals if you are
able.
• You will practice deep
breathing and coughing &
foot and ankle exercises.
• Your IV may be removed.
• Your wound will be checked
daily.
• You will get medicine
everyday to help prevent
blood clots from forming.
• Your oxygen will be stopped.
• Health care team members
will review your home
arrangements for discharge.
• You will have no
food or drink before
surgery.
• You will wake-up in
the Recovery Room.
• You will return to your
room with an IV and
maybe oxygen.
• You will get pain
medicine by a needle
so that you are
comfortable. You will
need to ask your nurse
for this medicine.
• You will get antibiotics
through the IV to help
prevent infection.
• You will get out of
bed with the help of a
physiotherapist and/or
nurse.
Day 3 to 4 After Surgery
Day 2 After Surgery
Day 1 After Surgery
TOTAL HIP & KNEE REPLACEMENT SURGERY – PATIENT PLAN OF CARE
Day of Surgery
28
Your New Knee
Table of contents
Topic
Page
Introduction............................................................................................................................. 2
Learning about knee replacement surgery................................................................................ 4
Getting ready for surgery.......................................................................................................... 6
Pre-admission clinic visit........................................................................................................... 7
Day of surgery.......................................................................................................................... 9
After surgery - in hospital . ..................................................................................................... 10
Knee rules............................................................................................................................... 13
Exercises................................................................................................................................. 14
How to move ....................................................................................................................... 17
Walking.................................................................................................................................. 18
Stairs...................................................................................................................................... 19
Follow up............................................................................................................................... 21
What to watch for following surgery....................................................................................... 21
Bathing ................................................................................................................................. 22
Driving................................................................................................................................... 23
Preparing your home.............................................................................................................. 24
Health Care Team Members.................................................................................................... 26
Additional appointments........................................................................................................ 27
1
2012
Looking for more health information?
Contact your local public library for books, videos, magazine articles and online health information.
For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca
Capital Health promotes a smoke-free and scent-free environment.
Please do not use perfumed products. Thank you!
Capital Health, Nova Scotia
www.cdha.nshealth.ca
Images and text by: Special thanks to Hamilton Health Sciences, Hamilton, Ontario, for permission to use information from “Your New Knee”.
Prepared by: Orthopaedic Health Care Team
We would like to thank our Orthopaedic Health Care Team at the Queen Elizabeth Health Sciences Centre (QEII), Capital Health, Halifax, Nova Scotia,
who provided us with comments and suggestions.
Designed and Printed by: Capital Health Audio Visual and Printing Departments
The information in this brochure is provided for information and education purposes only.
The information is not intended to be and does not constitute healthcare or medical advice.
If you have any questions, please ask your healthcare provider.
WE85-1223 Revised Sept. 2012
The information in this pamphlet is to be updated every 3 years.
Please visit our website:
www.cdha.nshealth.ca
Your New Knee
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