Having a total knee replacement (TKR) is a far cry from your typical doctor’s visit. It’s a serious undertaking that will have a complex impact on your life, both immediately following the surgery and for years to come. It’s important to take time to do your homework beforehand. Go through the process step by step to help ensure the best outcome from your surgery.
Preoperative and Preadmission Testing
You’ll undergo a preoperative evaluation and testing after you’ve made the decision to move forward with a knee replacement. Your medical team will determine whether you’re a suitable candidate for surgery. They’ll identify any potential complications. This will help make your operation a successful one.
You’ll most likely undergo preadmission testing (PAT) one to two weeks before your procedure. This testing can include:
- physical exam
- detailed questionnaire
- complete blood count, to rule out anemia
- urinalysis testing
- coagulation testing, to determine whether your blood will clot normally
- baseline metabolic analysis of your kidneys, liver, and electrolyte status
You may also have an electrocardiogram (ECG or EKG) to make sure your heart is healthy.
You’ll also meet with an anesthesiologist to review your health history. They’ll do preadmission testing to determine which anesthetic is best for you. The anesthesiologist may decide to use general anesthesia, which makes you unconscious during the operation. Another option is spinal or epidural anesthesia, during which you are awake but can’t feel pain from the waist down.
Your doctor will request X-rays and likely an MRI scan to fully understand the condition of your knee. These images will help your doctor to see details about your knee. The results will help them make the right decision about the sizing and placement of your implant. The images will also help determine the best surgical approach.
Your doctor may want to adjust your prescription if you’re currently taking any prescription medications. They may also prescribe new drugs, such as anticoagulants, to make the surgery proceed more smoothly. One major side effect of surgery is infection, particularly for those with weakened immune systems. You’ll also likely take antibiotics as a prophylaxis against postoperative infections.
You should stop taking all aspirins or other medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) one week before your procedure. This includes naproxen (Aleve) or ibuprofen (Motrin, Advil). You may take acetaminophen (Tylenol) for any pain or discomfort. This step is to ensure that you don’t have postoperative bleeding complications.
Your doctor may talk to you about blood banking. Banking blood means having your own blood drawn and saved prior to the surgery, so that it’s available to use if a transfusion is needed during the operation. About 20 percent of people having a TKR need a transfusion. You’ll receive screened blood from a blood bank that matches your blood type if you can’t or choose not to bank your own blood before surgery and you end up needing a transfusion during surgery.
Your doctor or physical therapist may also ask you to participate in a muscle-strengthening program before the surgery. The American Academy of Orthopedic Surgeons finds that people who have a TKR who start physical therapy and strengthen their muscles before surgery achieve a faster and better recovery. The added muscle helps your body adapt to the implant and withstand rehabilitation better.
The exercises you do before surgery will help your rehabilitation by making your body stronger and able to heal better. These include exercises to increase your upper body strength to help you use crutches after your surgery as well as exercises to strengthen your legs. Exercises you may want to try include:
- ankle pumps and circles
- thigh squeezes
- heel slides
- leg slides
- lying kicks
- straight leg raises
- knee bends
- sitting kicks
- chair push-ups
Your surgeon might also request that you attend a class that thoroughly explains the procedure. The class will help you understand what will take place at every phase of the knee replacement process. Trained nurses usually teach these classes, and the class may be hosted at your scheduled hospital. You might also receive a DVD that explains all the steps from admission to discharge.
Your surgeon’s office will usually schedule the surgery four to six weeks from the time you have agreed to the procedure. The wait is a good thing: You can use this time to prepare both physically and mentally.
As with any surgery, recovery isn’t easy. Expect some pain and discomfort. You may also experience some frustration over your limited ability to move around. It may help to read about experiences from people who have had a TKR to get a good sense of what to expect.
And when things do get challenging, focus on the rewards of once again being able to engage in your favorite activities. You can increase the odds for a faster and smoother recovery with the right preparation.