Double knee replacement surgery—part 2: Pre-op classPosted: January 24, 2012
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.
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
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
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.