The Surgery Experience – Total Knee Replacement
After you meet at the hospital you will be taken to the pre-anesthesia room or holding area. There you will meet the nurses and and the anesthesia team who will be taking care of you. Dr. Cuellar will see you right before the operation to go over any last minute questions and to identify the correct operative site. This will be asked several times throughout the preoperative time. The correct operative site will be marked with a pen.
The nurse will start an IV (intravenous) line in your arm. This allows us to give you medication and fluids quickly. Most patients are a little nervous at this point. This is very natural. Usually, to address this issue, the anesthesia team will give you a medication that will help calm you down. Also, you will be given an antibiotic. This antibiotic will be administered for 2 days post op.
There are several choices for anesthesia. The anesthesia team will discuss these choices with you. These include general anesthesia, spinal block, epidural block, femoral nerve block and sciatic nerve block. General anesthesia is when you are given medication that places you in such a deep sleep, you are unable to feel anything going on during the surgery. The spinal block is an injection of a local anesthetic into the lumbar area of your back containing the nerves going into you legs. This is a one time injection and usually lasts for hours. The anesthesia team will give you a sedative to help you relax throughout the operation. An epidural anesthetic is similar to the spinal block in that they are both given in the lumbar spine area. However, the epidural is delivered in a different “space” than the spinal block and a catheter (sterile tube) is left in place so that more medication can be given if needed. Sometimes, the catheter will be left in the back for pain control after the operation. Finally, the femoral and sciatic nerve blocks are injections that are given to specific nerves that go to the knee. Catheters can also be used for the femoral and sciatic nerve blocks.
While you are in the operating room, Dr. Cuellar typically places a Foley catheter into your bladder. This is done after you have been given an anesthetic to eliminate any discomfort. The Foley is primarily used for your convenience as urinating immediately after surgery can be a difficult task.
After surgery you will go to the post-anethesia room or recovery room. There, the nurses will help you in the waking up process. Also, they will administer pain medication as you need it. Usually you are in the recovery room for about 1 to 1.5 hours. Once you are completely awake and pain is well controlled you are taken to your room where a different nurse will take over your care.
Immediately after surgery, you will have several tubes going into you body in one form or another. These include the IV, Foley and a drain that goes into your knee. The Foley and drain will come out on your second post op day. The IV will be removed later.
You will be given pain medication via your IV or orally. Pain control is very important and there is no reason for you to endure severe pain. Therefore, let your nurse know when you are uncomfortable.
One of the major concerns after having a knee replacement is the development of blood clot. These form in the legs and become dangerous if they break off and go to the lungs (pulmonary embolism). We recognize this can be a problem and therefore we do everything we can to prevent such a complication. This includes administration of a blood thinner. Sequential compression devices are placed on your legs. These are pneumatic devices that help push blood from your legs to your heart. Compression stockings are placed on you legs also to help with circulating your blood from your legs to your heart. Finally, we get you up as soon as you can tolerate it.
To help your breathing, the nurses will help you exercise your lungs by blowing through a special device called an incentive spirometer.
Physical and occupational therapy will be started immediately after surgery. You will have therapy at least twice a day. While in the hospital you will use a CPM or Continuous Passive Motion machine. This will help you move the knee without having to use your muscles. This allows you to get therapy while in bed. This does not replace physical therapy, it enhances it. This will progress until you are discharged.
Most patients are in the hospital for about three to four days depending on circumstances.