Double knee replacement surgery—part 2: Pre-op class

We’re moving forward on our preparations for Mark’s double knee replacement surgery. Last week Mark had an appointment with a physical therapist to get fitted for knee braces. The braces prevent the knee from bending. Mark will be wearing these for the first two days after surgery when he is not in therapy.

Post-knee surgery braces

Mark actually got two different braces. The one on the left can be adjusted to allow the knee to bend to some degree, the one on the right doesn’t allow any rotation. The therapist told Mark that usually one knee is better than the other following surgery. If that is the case, he may be allowed to bend it some to help with mobility. We have to bring these to the hospital the morning of surgery.

Last Thursday Mark and I attended a pre-operation training class at the hospital. We were in a room with seven other people who were having knee or hip replacement surgeries. Mark was the only double-knee replacement surgery patient in the class. I’m going to spare you all the details and just hit the highlights.

The trainer told us we will need:

a walker without wheels
a raised toilet seat
shower chair

Mark was given a booklet with information on:

what to expect and do the day before and the day of surgery
a list of personal items he may want to have with him at the hospital
hospital care
home care
and exercises (to do starting right now, 3x/day until the surgery)

According to the booklet Joint Replacement at Good Samaritan Hospital, “Very little bone is removed during a total knee replacement — usually less than a half inch on all sides of the joint. For the most part, the patient’s tendons and ligaments are preserved to allow the new artificial surfaces to glide and rotate much like a normal knee joint. [...] Your orthopaedic surgeon will enter your arthritic knee through an eight to ten inch midline incision. After opening the knee, ligament balancing and deforming bone spurs will be addressed. Bone cutting jigs will be secured to the knee bones so that precise shaping can occur. [...] Realigning your knee so that it is properly positioned between your hip and ankle is critically important for proper function and long-term durability. The actual implants will then be secured to your knee bones with cement or through a press-fit technique. [...]After the implants are secured to your knee bones, your orthopaedic surgeon will test the new knee for balance and tracking of the kneecap. [...] Final adjustments can be done to maximize the range of motion and stability of your knee. Then deep and surface tissue layers are securely reattached to allow early motion and purposeful physical therapy.”

Mark’s surgery should take about three hours.

Following the surgery Mark will have precautions, or moves or positions he is not allowed to do, until he is completely healed after 2 to 3 months. Precautions for knee-replacement surgery are:

No forceful twisting or torquing at the knee (like when you twist your foot back and forth to try to get a shoe on).
No crossing the foot over the other knee to put a shoe on.
No deep squatting.
No kneeling directly onto surgical knee/s

All knee replacement patients will be full weight-bearing after surgery, which is a good thing since Mark will not have a non-surgerical knee to rely upon.

For the first 24 hours Mark will have pain relief through a nerve block or IV pain meds. After that the medicine is PRN, which means, prescribed, but not allowed to be given unless Mark asks for it. It is designed to bring pain down to a level of 4 or less on a scale of 1-10. Pain gives the body feedback and some level of pain is needed to keep the patient from overworking or injuring the joint.

The trainer told us to ask the doctor:

What pain medicine has been prescribe?
How often is it allowed?
When is the next time he is allowed to take it?

We were advised to keep track of the pain med schedule (which I always do anyway), and ask for meds about 30 minutes before it is due to give the nurse time to work it in.

Therapy will start the day of surgery for Mark since his surgery is scheduled first thing in the morning. This is a good thing. The sooner he starts moving his legs around the better, we were told.

Starting the second day, Mark will have two physical therapy sessions and two occupational therapy sessions—both will be held in his room. If he does really well with the occupational therapy he might “graduate” early. When he leaves the hospital on day 3, Mark will be able to get in and out of bed, stand up, sit down, walk with a walker, go to the bathroom, get dressed and climb stairs.

Mark will be going to physical therapy 2 or 3 times a week, probably starting the day after he gets home.

Mark’s particular doctor prohibits showering for 14 days following surgery. He will not be allowed to drive for 4 to 8 weeks and will need a doctor’s release.

Following the training, Mark went for some basic pre-op testing where he was given this breathing device. I don’t know exactly what it is used for, except to keep the lungs clear following surgery.

He was also given these surgical wipes to use over his entire body the night before the surgery to help prevent staff infections.

The braces and  the breathing device need to arrive with Mark at the hospital before surgery.

The booklet, a walker if we have one (if not, we will get one there), and his bag with clothes and personal items all need to be brought to the hospital, but I was advised to leave those in the car until Mark has a room so that I won’t be dragging them around the hospital with me.

Our daughter Anna has offered to wait with me at the hospital during the five hours it will take for the surgery (3 hours) and recovery (2 hours). I found out Thursday that the hospital does have free wifi, so hopefully I will be able to keep myself occupied by blogging and reading. I have three books on my Kindle that I’m trying to read by the end of February.

As we learn more of the details, the surgery becomes more real, which is frightening for me. But it is also comforting to find out the details and doing so mostly reassures me that we can do this.

Since I wrote this last Friday, we have acquired a walker and a raised toilet seat that we borrowed from Mark’s mother. Yesterday I bought a shower chair, so we should be good to go. As more and more of these appliances and devices come into our home, Mark gets more and more disconcerted or anxious. We had to put the toilet chair and shower seat in the spare bedroom so that he wouldn’t have to look at them.

For me it is a relief because I feel like we are getting prepared.

Mark is also in more pain with his knees since he is not allowed to take his pain medicine for two weeks before the surgery.

My biggest concern at the moment is being able to get out to get medicines, food, or other items that we may need during the two weeks I am supposed to be with Mark 24/7. I am trying to plan ahead. For example, yesterday I noticed we are running short of stamps. I will have to make a trip to the Post Office before Monday. After Mark’s surgery, I will have to use the time he is at therapy to run necessary errands. Our daughter will be back the first weekend Mark is home, and our son is a student at the college in town about a half hour away. I hope he will be able to take time away from his classes to help me on the day Mark comes home. I am expecting there will be items and medicines I will need to pick up that day, unless someone can give me the discharge instructions early.

You can find links to the entire series on Bilateral knee replacement surgery here.

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23 Comments on “Double knee replacement surgery—part 2: Pre-op class”

  1. Colline says:

    I hope his surgery goes well. I did not realise that so many preparations were required.

    • CMSmith says:

      Thanks, Colline. I think the doctors used to “take care” of you more before when you might stay in the hospital rehab for up to a month after surgery. Now you are on your own more, and the information and preparation are vital.

  2. Beth Ann says:

    My brother had just a single knee surgery last year and he did so great–I am sure Mark will, too. The most important thing that they told my brother was to make sure you stay on top of doing the physical therapy—that makes the difference between the having a successful surgery and a not so successful surgery. It sounds like you are going to be the best nurse ever!

    • CMSmith says:

      Thanks for the encouraging story about your brother. We know about the importance of therapy. I think Mark will rise to the occasion. It will be our project for the next few months.

  3. Who knew there was so much preparation involved. It sounds like you are in good shape. It’s fascinating to learn these details. Blessings and best wishes to Mark–and you, as care-giver.
    Hugs,
    Kathy

    • CMSmith says:

      Thanks, Kathy. I guess I am kind of glad for the preparation. I think the whole thing will be much less shocking as a result. At least, hopefully it will be.

  4. suzicate says:

    Youngest had the same/or very similar apparatus with his acl/mcl surgery.
    I understand the preparation and countdown…my hubby is having back surgery at the end of next month…we’re going to have to move downstairs for a while because I don’t think he’s going to be able to handle steps.
    Hope all goes well with Mark’s surgery and recovery.

    • CMSmith says:

      I’m sure you can relate. I like to think of myself as a modern, self-sufficient woman, but as I’ve aged, I’ve become more dependent on my man for some things. I guess this will be a wake-up call. (I’m still not looking forward to dragging the trash can up the hill.)

      At least we don’t have to move downstairs, although you might think of it as a little adventure, or change of scene. I didn’t know you couldn’t do steps with back surgery. The trainer at the hospital said the knee and hip patients would be able to do steps before they left if they needed to at home.

      I think the waiting for it might be the worst part. Good luck to you both.

  5. Wow, Christine — very involved, so it’s good that you’re so very organized! I hope you have lots of movies and/or book tapes lined up for the down times after he gets home — if you need some movie ideas, let me know! :-) Sending all good thoughts your way!

    • CMSmith says:

      Mark got a lot of dvds for Christmas. We’re finally going to be able to watch Band of Brothers in its entirety. And I got him the complete Taxi series. Then we have Netflix and a movie library of our own.

      But I’m always up for new ideas if you want to offer any.

      I don’t think there will be anything wrong with his eyes, so I’m pretty sure his kindle will work for books.

  6. A friend recently underwent double hip replacement and at 65 I am astonished how quickly he was up and around. That post op physical therapy is the key to recovery. I know other people who could benefit from an attitude replacement.

    • CMSmith says:

      You’re right about the post-op physical therapy. I’m glad to hear your friend was back up and around quickly. Hopefully I will be able to say the same about Mark.

      Attitude is everything.

  7. We went through this with my mother-in-law who was in her 70s. I think you seem well-prepared. Lots of luck to you both.

  8. pattisj says:

    It sounds like you have all the details. I remember when I had surgery on my cervical spine, I pored over everything I could find to read, like I had to KNOW it all. One day, the light bulb came on, I just had to follow doctor’s orders, one thing at a time. Praying for peace of mind for both of you.

  9. dogear6 says:

    How very good to have the advanced preparations. When my husband had his ACL replacement, they waited until he was at the hospital to tell him he needed crutches and had to learn to walk with them. After the surgery they told us he would need therapy and couldn’t drive for 10 weeks.

    I was so pissed off. I was working full-time and had no advanced warning to get any of this ready. The doctor simply couldn’t have cared less.

    It won’t be easy for you, but the advanced preparation helps a lot.

    Nancy

    • CMSmith says:

      You know, I was wondering about that. They only gave us about 10 days notice. I stay at home, so it’s not an issue, but I thought, what would we have done with this if I worked?

      Well, you figured it out. But you’re right, sometimes it is so routine for doctors that they don’t realize the upheaval in the patient’s and their family’s lives.

  10. nrhatch says:

    Glad that you are getting things sorted out now. Surgery can be scary . . . so the more “knowns,” the better.

    Fingers crossed that all goes well and that Mark has a speedy recovery.

    My favorite thing about surgery ~ the morphine drip. ;)
    My least favorite thing ~ not being able to shower as soon as I got home from the hospital. The first shower is HEAVENLY!

  11. I hope everything goes well.

    It sounds like a figurative mountain of things to do for preparations!

  12. Lucy Van Ryzin says:

    I was just wondering how the surgery went and how well the recovery is coming along. Both of my knees are shot and will have to be replaced but I am scared to do them at the same time. Hopefully Mark is doing well and you are not losing your sanity through the process and recovery.


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