Considering a Knee Replacement?

Maureen Robb's picture
By Maureen Robb on September 24, 2018

 You’ve lived with knee pain for a long time. It’s keeping you from activities you enjoy, and it’s interfering with your sleep.

You’re thinking seriously about having knee replacement surgery.

But how can you be sure it’s the right decision for you?

You definitely owe it to yourself to consider all the factors.

Getting Answers

Over 600,000 Americans get a total knee replacement every year, and most report great improvement after surgery.  

You may still have some pain, though, and your new knee won’t feel identical to your old one.

“Before having surgery, we like to help patients consider all their options,” said Linda Franklin, R.N., a certified orthopaedic nurse at Carilion Clinic’s Institute for Orthopaedics and Neurosciences. As the ambulatory joint care coordinator for the Institute, she acts as the liaison between patients and orthopaedic surgeon Joseph T. Moskal, M.D. as his direct care nurse.

“We ask you to come in, get X-rays and discuss your options with Dr. Moskal,” Franklin said. “I also talk to patients and give them an overview of what they might expect.”

Patients learn that the main goal of surgery is pain relief, and the secondary goal is increased mobility.

“We want everyone to make the best decision for their particular situation, with surgery as the last option once conservative options have been considered and tried based on the doctor’s recommendation,” Franklin said.

She also conducts classes every week for patients and shares with them a 50-page booklet she created to walk them through the knee replacement process. She worked with physical therapists, nutritionists and others on the health care team for their input in compiling the booklet. This allows patients to know what they can expect at every phase.

Family members who will act as caregivers are encouraged to attend as well. “We can’t do it without the family,” Franklin said.

In case you’re wondering, Carilion is unusual in offering such an extensive patient education program—called the Joint Academy. In fact Franklin has been asked to speak about it at various orthopaedic conferences.

Steps for a Speedy Recovery

Once surgery is scheduled, what should you do to promote healing after your knee replacement?

You’re asked to follow these steps starting seven days before surgery:

  • Be physically active three times a day
  • Do breathing exercises four times a day
  • Begin bowel prep with stool softeners
  • Start taking probiotics (you’ll take them for 30 days)
  • Begin mouth care, including brushing and using mouthwash twice a day
  • Begin taking Prilosec or the generic equivalent to treat heartburn if it isn’t already prescribed by your doctor

These steps will help you prevent infection, blood clots, post-operative nausea and thirst, pneumonia and heart issues.

Other concerns are also addressed:

  • Smokers are tested for carbon monoxide and nicotine levels and must be smoke-free for at least six weeks to three months before surgery
  • Your dentist must verify that your gums and teeth won’t pose an infection problem within a year of surgery
  • Patients are asked to have a BMI of 40 or under, and nutritionists are available to help you achieve this. Being overweight can cause complications during or after surgery, including those linked to wearing a prosthesis over time.
  • Your glucose level will need to be under 8 on the A1C test, and patients with diabetes must have it in good control

Since it’s important to be as fit as possible before surgery, your doctor may also ask you to do exercises to strengthen your entire body. “This will make recovery much faster,” Franklin said.

They include:

  • Ankle pumps
  • Quad sets (knee push-downs)
  • Gluteal sets (bottom squeezes)
  • Hip exercises
  • Knee extensions
  • Armchair push-ups
  • Mini-squats
  • Seated hamstring stretch

The wellness team from Carilion Starkey, which is part of Joint Academy, works with patients during class pre- and post-surgery to help them practice the exercises. Families are invited to observe.
 

Nutrition

Finally, eating a healthy diet is important in helping you to heal.

Before surgery, you’re asked to start eating:

  • 70 to 80 grams of protein a day
  • 22 to 35 grams of fiber from fruits, vegetables, beans and other whole foods
  • Foods containing iron (or an iron supplement)
  • Heart-healthy foods, including fruits and vegetables, grains and dairy products

Franklin also recommends drinking 70 to 80 ounces of water and other fluids every day.

Planning for Success

It may sound like a lot, but as Franklin says, “The more you can do to educate patients, the better. They become our partners in this process and understand not only what to do but the ‘how and why’ we ask them to do it.”

All the steps are designed to help you stay in the hospital only one to two days, and to recover as quickly as possible after you get home.

Statistics also show that even 20 years after surgery, most people who’ve had a knee replacement tend to be more active than their peers who haven’t.

So chances are you’ll be happy you made the extra effort to get the best possible outcome.

This is part 1 of a two-part series on total knee replacement. Next: What you can expect at the hospital and steps to take at home post-surgery for a speedy recovery.

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