Part One – Before the Surgery
By: Jean Johnson for Knee1
The knee is the largest joint in the body, both bearing the load of holding the body upright and also enabling it to move through space. When one or both of the knees wear out and the pain of moving becomes too great, a person may enter the world of orthopaedic surgery.
The seriousness of the prospect of having a knee replacement cannot be over-estimated and the recovery process, particularly, can get one’s attention in significant ways. This two-part article will focus first on the pre-operative phase of having a knee replacement and secondly on the recovery period.
| Help the Surgery Process by Being Prepared|
Give power of attorney to trusted family member or friend
Make a living will
List your medications, including vitamins and over-the counter drugs
List family contact information
Prepare items you’ll want to take to the hospital
Prepare at home for mobility limitations during your recovery
Learn exercises for recovery before the surgery, and do safe exercises to build strength
“I know when I got to hobbling around I put the surgery off as long as I could,” said Clyde Burton of Longview, Wash. “You’re laid up for so darn long after, and I didn’t want to put my wife through all that. Still, it got so where I couldn’t take enough aspirin or whatever it was I took to manage the pain. So in I went under the old knife.”
According to the American Academy of Orthopaedic Surgeons (AAOS), more than 638,000 knee or hip replacement surgeries were performed in 2003, the last year for which data is available. The academy offers a number of suggestions related to how to prepare for a joint replacement surgery.
As with other medical and dental procedures, the more patients and their families understand about the diagnosis and treatment, the better people will be able to enhance their own recovery and outcomes. The key here is meeting healthcare providers on cooperative terms and asking enough questions.
Often, clarification is necessary to understand medical terminology, but the AAOS encourages patients to take the initiative and not shy away from voicing concerns about what they do not fully understand. Asking physicians and surgeons to slow down and explain areas of confusion is just being a smart consumer, and most healthcare professionals will respect patients who the take trouble to inquire.
In particular, ask questions about the hospital admitting process, anesthesia, the type of implant that will be used, the length of hospital stay and pain management. Additionally, if you would enjoy seeing the family dog while you are recuperating, do inquire as many hospital wings allow family members to bring in smaller, well-behaved pets to see patients.
Getting the Paperwork Together
Major surgery requires lots of paperwork and prospective patients will face more questions than they ever thought people would ask of them. That includes many of the queries asked over and over by different people in different offices to make sure no stone is left unturned. That’s good thing – even if it can become tedious.
To make this process as easy as possible, it’s best to collect copies of medical papers into an envelope so they are handy. Clyde Burton found that things went off without a hitch once he made lists of his medications (including over-the-counter things), his allergies, diet restrictions and got his insurance papers and legal arrangements (living will and power-of-attorney) together.
“It was a chore finding all that information and getting certain forms and writing things down. But then when they start in with their questions, you can just hand over the papers and that’s the end of it,” he said. “I even had my name and address and social security number and all that on one sheet so I didn’t have to repeat all that stuff every time. At least most of the time,” Burton mused. “Sometimes, though, it seems like they’re just double checking to see if you still know who you are.”
Burton chuckles. “It’s true, I forget a few things here and there these days, but so far I remember my own name – and the missus of course – and the kids and grandkids, most of them anyway. There’s lots of those and more coming all the time. Even great-grandkids. You know your race is about run when that starts happening.”
Eating Right for Surgery; Leaving Off Tobacco and Alcohol
Any surgery taxes the body, so the more aces a patient can have in their hand the better, says Clyde Burton.
“I’m an old mill worker, you know, so I have my share of bad habits what with my beers and my cigarettes. On the smoking, I just couldn’t find the strength to quit completely – at least until after the surgery when, thanks to my wife dragging her feet, I kicked the habit for good,” said Burton. “Still, I did cut down from a pack to about five or 10 smokes a day. I quit my beers for a couple days like my doctor said to then too.”
Indeed, the AAOS suggests that no alcohol be consumed 48 hours prior to joint replacement surgery, and the association recommends that smokers try to either stop or reduce tobacco use.
Surgeons and anesthesiologists also need to know precisely what type of pain management patients have been using in the immediate window prior to the operation.
Diet is another way the AAOS suggests preparing for a knee replacement – not only a healthy one, but also one designed to reduce caloric intake if the patient carries extra weight.
“My doctor got after me I guess you could say,” Burton recalled. “I have let myself go a little I guess, but my family was always on the heavy-set side. Anyhow, he gave me some sheets to follow, but I don’t know that I did all that good. I did stop my desserts – my wife saw to that even though I sure missed a piece of pie or something like that after dinner.”
Burton added that he did lose some weight after the operation “since I sure didn’t feel like eating then. But I guess that’s all come back on by now.”
Getting in the Car without Straining the Left Knee
It’s true that many knee replacement surgeries are required because of pressure placed on the joints by more weight than the body was designed to carry. The cartilage that pads the bony surfaces simply wears out. A person’s habitual movements, though, can also play a role.
| Ways to avoid a knee replacement:|
Keep your weight down
Exercise the muscles that support the knee
Do activities like swimming and walking and cycling on flat surfaces that are easier on the knees than more jarring sports.
Consider getting into a car on both legs by sitting down sideways first and then swinging the legs in.
“I always get in the car ‘butt first’ now, if I can put it that way,” Burton said. “It was my left knee that they did and while I realize my weight didn’t help, my doctor did say and turning on that one knee all those years getting into the car was probably a factor.”
Virgie Kobell from Portland, Ore., who also had a knee replacement agrees with Burton that the knee was never designed to torque the way it does when a person swivels into the car on one leg.
“Not only do I think that way of getting in a car wasn’t good, my daughter, who is in her 50s, started complaining of a sore left knee. After I told her I thought my trouble was from getting in the car, she changed and sits down first now before swinging her legs in. Her knee pain has completely vanished.”
Just the thing a person in knee pain does not want to think about before surgery is exercising. Then again, if a patient is able to entertain some upper and lower body work, they can make their recovery process go more smoothly.
“That’s true about the exercises even though I didn’t do any,” said Kobell. “I’ve never been an exerciser, but I see now that if my arms had been stronger, using the walker would have been easier. They also mentioned just squeezing my thigh muscles and holding it for a little bit, but I was in too much pain to try that.”
The AAOS does say that both isometric leg muscle work and arm work that strengthens muscles can help patients recover more easily. The organization also suggests that patients familiarize themselves with post-op exercises ahead of time.
“I did do that,” said Clyde Burton. “My wife helped me go through the papers and learn the exercises. That was pretty good because after the operation you have that big bandage on your leg, you know. Things are pretty cumbersome then so you have enough to deal with there.”
Even Virgie Kobell said she wished she’d learned her post-op exercises ahead of time. “Yes, I should have because afterward you have no choice,” she said. “You have to do them if you want to get your mobility back. And since I didn’t know the first thing about exercising, it was quite a job. I admit that many days it was just too much for me, and my doctors have told me that’s why I still don’t get around all that well.”
Making the House Accessible and Filling the Freezer
Life will be dramatically different during recovery from knee surgery, so planning ahead helps. Remove all throw rugs, make sure electrical cords are out of the way or taped down securely and consider putting your bed in the living room for awhile. Also, get the bathroom set up with a raised toilet seat (that fits right over a standard commode), a shower stool and grab bars by the toilet and in the shower.
Thinking ahead on food also helps. “Even though my wife was there to cook, she still made soups and things ahead for a few weeks and put them in the freezer. That helped out since she was awful busy with me and didn’t have so much time to fuss in the kitchen as usual,” said Burton.
Kobell agrees. “Since I’m the family cook, I really had to think about it. I made all kinds of things and had both our freezers filled, so that worked out nicely. My son picked up fresh bakery bread, so between that and my cooking ahead, we were well taken care of.
“On the living room arrangements, though, I didn’t do that,” Kobell said. “I’m way too proper to have my bed in the living room like some old lady. My bedroom is a perfectly fine place to be in. I didn’t mind at all.”
Kobell also said that all the new tools her surgeon had her get for her recovery period could be stored easier in her bedroom and bathroom. These are essentially a variety of aids with long handles to help with the activities of daily living; things like long handled shoe horns, a grabber or reaching tool to avoid bending over and a long-handled sponge for the shower.
The Day Before
The AAOS recommends showering the night before (and not shaving the legs) to reduce the risk of infection. Aside from following the surgeon’s nothing by mouth order after midnight, most of the challenge is to pack a case with useful items for the hospital stay.
Slippers with non-skid soles, a T-shirt or camisole to wear under the hospital gown, glasses and personal hygiene items are about all one will need in addition to a loose jogging suit or other stretchy, comfortable clothing and shoes to wear home. All jewelry, cash and credit cards should be left at home or in a safety deposit box at the bank if the patient lives alone and plans on going to a nursing home for the recovery period.
Continued in Part Two