I had the opportunity to experience recovery from a TKA through the eyes of a close family member, who I, as a joint replacement surgeon was the primary caregiver. This experience gave me a new appreciation of what our patients experience in the weeks after TKR. I will break this up into segments: pre-op, day of surgery and the first day of recovery, day 2- day 6, and weeks 2-6.
Day of Surgery and First Day of Recovery
You will arrive at the facility 2-3 hours before your actual surgery start time. Remember, no solid food for 6 hours but you can drink clear liquids ( water, sports drinks, coffee no cream, tea ) up till 3 hours before surgery. This is actually good to keep you hydrated and your kidneys working. You have taken your usual prescription medications as directed by your doctor. You check in at the facility and are asked multiple times “what procedure is your surgeon performing”. Having washed with special antimicrobial soap over the last few days you feel squeaky clean. You change into a hospital gown, wipe down again with antiseptic wipes. They then have you clean your nose with an iodine solution, this will burn but kills bacteria. The nurses ask you about your medical history and the anesthesiologist comes in to meet you. They discuss the multi-modal approach to anesthesia and pain. You will receive pre-op Tylenol, an anti-inflammatory medication and other medication to minimize an upset stomach. The circulating nurse will come and meet you in the pre-op area. She will roll you back to the operating room. You will meet your team, the scrub tech, and anesthesiologist. The OR can be cold, but we have warm blankets. There is lots of equipment and monitors. In the operating room, a spinal anesthetic and knee nerve block will be performed by anesthesia. You will be given sedation so you will drift off to sleep. The operation is completed and you are off to recovery.
The first thing you remember is the recovery room. A recover nurse monitors your vital signs and once our anesthesia has worn off you are off to your room if you spend the night or to a step-down recovery if you are going home that day. You will sit up in bed and dangle your legs. Physical therapy will see you and begin walking and range of motion exercises. Icing and elevation help decrease pain and swelling. The medication and effects of the blocks make the first day not so uncomfortable. Often you will receive an IV dose of steroids to help with nausea and pain and this may make sleep on the first night a bit challenging. Working on bending and straightening of your knee and straight leg raising exercises is your goal for the day of surgery. The next morning your knee may be more sore as the blocks have worn off. Multi-modal pain management helps as will ice, gel packs, ice machines. More walking and range of motion exercises. Elevating the leg for 30 to 60 minutes at a time is really helpful. Keeping distracted with books, TV, music or other diversions is very helpful to take your mind off the discomfort.
You are on your way to enjoying your new knee but some hard work will be required. Don’t get discouraged remember to ice and elevate. See the picture above the post. Notice the foot is higher than heart and ice cuff on the knee. Remember, the knee is straight to assist in gaining knee extension.