PRE-OPERATIVE PATIENT EDUCATION

Please review the following instructions and videos to familiarize yourself with your post-operative instructions. Your nurse will go over these again on the day of your surgery. Please call the office If you have any questions.

TWO WEEKS BEFORE SURGERY

Have your preoperative appointment with the Weir Orthopedic medical staff to go over any medical issues or discuss any additional questions you may have.

Stop taking anti-inflammatories (Motrin, Aleve, Ibuprofen, Advil) unless directed otherwise by your doctor

Stop taking vitamin E capsules and herbal medications such as flaxseed, glucosamine and fish oil

ONE WEEK BEFORE SURGERY

Stop taking aspirin, plavix or coumadin if allowed by your cardiologist. Dr. Weir strongly encourages discontinuing these medications 7 days prior to surgery if approved by your cardiologist.

Start washing your whole leg with Hibiclens (4% CHG) soap once a day when you shower.

The hospital’s Pre-Admission Testing nurse will call you to review lab results and records the anesthesia department may need prior to your surgery.

The supply company of the continuous passive motion (CPM) machines will call you if a CPM machine is recommended for your surgery. They will discuss delivery times and insurance coverage with you. These machines are optional but most of our patients think they are an essential part of their recovery.

THE DAY BEFORE SURGERY

Stop taking “bridging” medications like lovenox or heparin by at least 8 am the day before surgery.

The hospital’s surgical scheduler will call you in the late afternoon to tell you the time you should arrive for your surgery in the morning.

Sleep well - your virtual surgery has already been performed by your surgical team and they are prepared for your robotic procedure tomorrow.

OVER-THE-COUNTER MEDICATIONS

These are the over-the-counter medications you may need during your recovery unless otherwise directed by your doctor.

Aspirin 81mg - Take one a day for 6 weeks to help prevent blood clots.

Tylenol 500mg - Take two pills every 6 hours for baseline pain relief. Discontinue tylenol when you no longer require any pain medication

Prilosec OTC - Take one a day while you are taking prescription Mobic or Meloxicam

Colace or Laxative - Take as directed while on narcotic pain medication.

Hibiclens (4% CHG) soap

DISCHARGE AFTER SURGERY

Some patients go home the same day of surgery, some stay in the hospital before going home and others go to a rehabilitation center. Discharge after surgery depends on your individual needs and the type of surgery you are having. Discharge planning nurses and physical therapists will work with you on coordinating your home needs or arranging a stay at a rehabilitation center if you are admitted to the hospital after surgery.

CONTINUOUS PASSIVE MOTION MACHINES

A continuous passive motion (CPM) machine is a tool that helps you work on bending your knee during the first few weeks after surgery. Most of our patients think they are an essential component of their recovery. There is no exact amount of time or total degree of bend that is right for every single person. The goal is to get as much range of motion as possible during the first two weeks of your recovery so that you are ready to start formal outpatient physical therapy. Most insurances cover the CPM machine for knee procedures. You can discuss with the CPM supplier and your insurance company to see if you have coverage. You can elect to pay directly for the machine or work on passive range of motion on your own without the machine if your insurance does not cover the CPM machine.

HOME NURSING AND THERAPY

Nurses and therapists will come to your house to help following full knee replacement. They perform the following healthcare duties:

Communicate with Dr. Weir about your progress and recovery
Care for your dressing and wound as it heals.
Start therapy for range of motion and strengthening of your knee
Assess medication and collect blood work if needed

OUTPATIENT PHYSICAL THERAPY

Outpatient physical therapy usually starts two weeks after surgery. This will be coordinated through your home physical therapy company if you had a surgery that required in-home therapy. If your surgery did not require in-home therapy, your outpatient therapy will be coordinated at your first postoperative appointment.

ACTIVITY

You may put your full weight on the operated leg unless told otherwise by your physician. Use a walker initially and progress to a cane in the hand opposite the side of your knee surgery. You can go without the cane when you feel steady and comfortable. It is good to be up at least every two hours for short walks around the house. Do not stand for long periods of time during the first few weeks.

EXERCISE

There are two key focuses for the first weeks of recovery:

Get your knee to go flat. The more you can get your knee flat the better you will do. Do not sit for prolonged periods in a recliner style chair with your knee bent. It is far better to keep this knee straight by propping it on another chair.

Bend the knee. This may be difficult and have pain associated with it at first but it is important to continue to work on bending to have a good postoperative range of motion. Taking your prescribed pain medication is important to allow you to be as comfortable as you can while working on your bend. Call for a refill of your pain medication as needed.

Use your continuous passive motion (CPM) machine as a tool to help you work on bending and flattening your knee. Focus on regular use of your machine and good pain control with your prescribed medication to get as much range of motion as possible during the first few weeks of recovery. The amount of time and total degree of bending will be different for each person. Work on manual range of motion if you do not have a CPM machine.

Additional daily exercises to start when you get home:

Straight leg lifts. lay on your back. Bend the non-operative knee to a comfortable position. Straighten the operative leg. Lift the operative leg up while maintaining the straight position. Do this in a set of 20 repetitions, 3 times a day.

Foot and Ankle pumps. Move the ankle up and down (like pushing and lifting off the gas pedal) on both legs. Do a set of 15 every hour while awake. This exercise is important to reduce the risk of blood clots.

SHOE INSERTS

Most patients find that wearing a supportive tennis shoe with a Dr. Scholl’s gel insole helps make their recovery easier. Regularly wearing this shoe and insole combination for the first 3 months helps to ease the stress in the knee and makes your recovery easier. Dr. Scholl’s gel insoles can be purchased over-the-counter from most pharmacies.

STAIRS

You can go up and down stairs unless your doctor has told you otherwise. Go up the stairs one at a time starting with the non-operative leg. Go down the stairs leading with the operative leg. Use a handrail whenever possible.

BATHING

You can start showering two days after surgery. You may shower with your Aquacel on. Do not soak the knee in a tub or pool until after your first office visit.

DRIVING

You will need to be off narcotic pain medication and feel safe to operate a motor vehicle before you start to drive. Most patients feel this way after just a few weeks depending on the type of surgery and the leg they had surgery on.

POSTOPERATIVE APPOINTMENT

An x-ray will be taken, your knee will be examined and we will discuss physical therapy at your first post-operative appointment. We can also discuss the timing for returning to work and sporting activities at that appointment. You will receive a card with the date of your first postoperative appointment.