Total Knee Replacement
General Information

Preoperative:
This will take approximately 30 minutes for surgical consents and instruction regarding your surgery. Bring a list of current medications including the drug name, dosage and times taken each day.

Preadmission Appointment:
It is important that you attend a seminar at the hospital approximately a week before the surgery. At this seminar you will be thoroughly informed about all aspects of your upcoming surgery, what to expect during your hospitalization, and arrangements will be set for your care after leaving the hospital. Many patients do not have anyone to care for them at home after the surgery. We understand that and will make arrangements for your care, which, in most cases is covered by insurance and/or Medicare.

If you have a heart or lung condition or are insulin dependent diabetic, you must see your medical doctor before surgery and receive medical clearance.

Postoperative:
You will be appointed to see Dr. Levy again about 10 days after surgery. Most of the time, sutures are not used to close the wound, so you do not have to worry about their removal. Prior to leaving the hospital, you will be given instructions on wound and dressing care. Most of the time, it is permissible to remove the dressing on the 5th or 6th day after the surgery and start taking a shower. As long as you keep the area very clean with plain soap and water, it is not usually necessary to replace the dressing after that.

Length of Surgery:
This operation usually takes Dr. Levy approximately 1 hour to complete. You will then be in recovery room for an additional 1-2 hours before going back to the ward.

Length of Hospitalization:
Average stay is 3-5 days.

Anesthesia:
The choice of anesthesia is between you and your anesthesiologist, who you will meet prior to the surgery. Usually a general anesthetic is used.

Blood Transfusions:
Before your surgery, a blood count will be obtained to see if it is necessary for you to donate your own blood. However, most of the time, transfusions are not necessary, and it is not necessary for you to donate your own blood unless your blood count is below a certain level. It is advisable to take iron tablets for about six weeks prior to the surgery. It is also not absolutely necessary for you to stop aspirin or anti-inflammatory drugs prior to the surgery. Although they can cause some increased bleeding, it is usually not a big problem, and most people become too uncomfortable before the surgery if they stop them. In addition, for safety reasons, you will be placed on blood thinners after the operation anyway.

Additional Information is available on Rehabilitation.

Physical Therapy:
While in the recovery room, your leg will be placed in a continous motion machine (CPM), the purpose of which is to facilitate the return of the range of motion of your knee. You will need to use this for about 6 to 8 hours a day for the next two weeks or until you have regained 90 degrees of knee flexion. Physical therapy will begin on the first post-operative day, and will be arranged on an outpatient basis after you leave the hospital. Arrangements for the CPM and outpatient physical therapy will be made for you.

Crutches/Walker:
Initially, you will need to walk with the aid of two crutches or a walker, whichever you are more stable with. Most of Dr. Levy's patients will need the walker for 3-4 weeks after the surgery, and most will require a cane for another 4-6 weeks. This is highly variable with some requiring the walker for months and others off the cane in a few weeks.

Brace:
A knee immobilizer will be placed on your knee in surgery. This is used for comfort and support. You will need to wear this brace when out of bed until instructed otherwise by the therapist or the doctor.

Wound Care:
The surgical dressing will be on your leg for about two days. When the dressing is changed, your incision will be covered with gauze. You may keep the incision open to air as long as there is no bleeding or drainage.

Driving:
Most patients are able to drive safely four to six weeks after surgery.

Return to Work and Permanent Restrictions:
After any total joint replacement, it is advisable not to run or jump and it is also necessary to avoid repetitive heavy lifiting. Sports such as tennis, racket ball, any contact sport should be avoided. However, activities such as golf, rapid walking, swimming, and bicycling is not only permissible but also actually helpful.

As long as your occupation does not involve the prohibited activities listed above, you may return to work when you feel you can do so safely. Most patients return to work between 4 to 8 weeks after surgery, at least at partial duty.