Health Considerations Before Knee Surgery
When you’re getting ready for a knee operation, here are some important things to know, especially since knee surgery has possible complications.
What do I need to do to prepare for knee surgery?
Reading the information on this site, communicating with your surgical team, and paying close attention to the checklists will best help you prepare for knee replacement surgery. The importance of preparation and information to successful surgery cannot be overemphasized.
What health conditions must be considered before undergoing surgery?
Some patients have unusual problems, such as HIV infection, hemophilia, cancer, bleeding disorders, liver or kidney transplants, enzyme disorders, and other conditions that require specialty consultations before surgery. If these considerations apply to you, your medical team will work with you to obtain the necessary testing and treatment prior to surgery.
What medical testing is needed prior to knee replacement surgery?
Pre-surgical checks are essential for your safety and it is unwise to short-circuit them; they are comparable to pre-flight checks that every responsible pilot makes before taking off. Out-of-town patients, or those traveling long distances, can have local doctors perform these checks. Usually, your medical team will work with your doctors to expedite this.
The typical pre-surgical checks are listed below; your doctor may include others.
Medical Check: Prior to your surgery, you should see an internal medicine specialist to identify and manage your health risks. Examples of increased risks are heart and lung disease, tooth and gum disease, infection, obesity, and diabetes. That is why patients should undergo testing and clearance by a medical doctor prior to knee replacement surgery.
Dental Check: A dental check-up is necessary to identify any hidden infection in your teeth or gums. Such infections must be treated before knee replacement to eliminate the risk that bacteria from decayed teeth enter the bloodstream and end up infecting the knee implants. If you are traveling from out of town, visit your dentist and forward the information to your surgeon.
Heart Check: If there is any reasonable suspicion of heart disease based on your history, it is best to find out ahead of time if your heart is healthy enough for knee replacement surgery. Heart disease is usually silent; patients do not have symptoms until the heart is stressed. If indicated, you will be asked to see a cardiologist before surgery for clearance.
What if I have bowel problems?
Pre-existing trouble with constipation usually leads to constipation and related problems after knee replacement. If you regularly take supplements to encourage bowel movements, let your doctor know so they can plan accordingly, since medicines used during and after surgery can result in serious constipation.
You will be given a stool softener before surgery to avoid problems with constipation later. Even so, you can probably expect disturbance of bowel patterns and at least some degree of constipation after knee replacement surgery.
How does diabetes affect my surgery?
Blood glucose levels over 200 will lead to poor wound healing and increased risk of infection. Therefore, it is critical that your diabetes is under control prior to surgery. A medical consultation and lab data before surgery will help your team to ensure your diabetes is controlled and your surgical risk is minimized.
Does osteoporosis affect the success of a total knee replacement?
No. If bone has severe osteoporosis, it may not be possible to use an un-cemented prosthesis. However, the cemented version of total knees can be implanted in nearly every type of bone, including bone that has osteoporosis, and the outcomes are very successful.
What about alcohol and drug use?
Regular alcohol consumption should be disclosed to your anesthesiologist and surgeon ahead of time. Alcohol withdrawal can happen to anyone, regardless of economic or social background. When it happens, it can be life threatening and can complicate your recovery from surgery. If your physicians know about alcohol consumption, they can take steps to avoid withdrawal. The same is true of recreational drugs. Be sure to talk about this with the anesthesia doctor.
What if I am a smoker?
Smoking increases the chance of lung complications during and after surgery, delays wound healing, increases the risk of complications after surgery, and increases the odds of residual knee pain even after successful knee replacement. Therefore, you should try to stop smoking, both for your general health, and to improve the odds of a successful result from knee replacement. Most hospitals are smoke-free, and you may not be able to smoke on the premises.
Does my body weight affect knee replacement?
Obesity will increase the risk of complications from surgery, such as blood clots and slower wound healing. Ideally, your weight should be within reasonable limits before knee replacement surgery. In some cases, for excessively heavy patients, knee replacement is not an option without drastic weight reduction, such as with gastric bypass surgery.
That said, many people are somewhat overweight and unable to lose weight while dealing with a painful arthritic knee. The knee components are designed to handle enormous loads, and are safe, even in very heavy people. There is no evidence to suggest that the components loosen up prematurely, or wear out prematurely in heavy people.
Exercise Before Surgery
What about dieting and exercising before surgery?
Maintain a nutritionally sound diet including a variety of foods in preparation for surgery. Crash dieting is not necessary; rather, regular exercise will help control weight and improve overall health.
Exercise before surgery, done within reason, and within the capability of the patient, will improve the recovery from knee surgery. Therefore, a reasonable exercise program to strengthen your thigh and calf muscles before knee replacement surgery is the best thing you can do to speed up your recovery.
How can exercise before the surgery help my recovery after?
Exercising and strengthening the thigh and leg muscles before the operation will result in faster recovery and return to function, with less suffering, struggle, depression, and mood swings. Consultation with a physical therapist before surgery can be very useful.
The reason exercise helps is that the knee, even if worn out, is a living joint. Living tissues respond positively to physiologic stress, and exercise is known to improve self-perception, esteem, and outlook.
Preparing for the Hospital
When do I first visit the hospital?
About a week or so before surgery, you will visit the pre-op department in the hospital. This visit is to read and sign consents for the surgery, for the anesthesia, and for blood products (if needed). You will have lab tests, possibly a chest X-ray, and an electrocardiogram. Please make a list of your medications and their dosages prior to this visit.
At this visit, you will be instructed on where to report on the morning of surgery. You will receive instructions on not eating or drinking after midnight the night before your surgery. This includes chewing gum and hard candy.
Keep in mind that surgery schedules change often; this is why the exact timing of the operation is not known until the day before. If you have a special preference, such as being the first in the day, or last, or in between, simply let the surgeon know and they will do their best to accommodate.
When will I be assigned a surgery time?
The hospital will contact you a day before the surgery to tell you what time to arrive at the hospital. Surgery schedules tend to change, which is why most hospitals will confirm the exact surgery time only a day or so before the operation. Please arrive early. The actual operation will usually be less than an hour in duration, but preparation takes much longer.
When do I see the anesthesiologist?
On the morning of your surgery, you will see an anesthesia doctor (anesthesiologist) who will have already reviewed your medical records. If your medical condition so requires, your surgeon will have consulted with the anesthesia doctor ahead of time. This doctor will inquire about your health and plan the anesthetic technique, including any regional nerve pain blocks. If you know of a particular anesthesiologist at the hospital whom you would prefer to provide this service, simply let someone on your medical team know ahead of time.
Should I donate my blood for surgery?
No. This is not necessary since not everyone needs a blood transfusion after knee replacement. If you have religious convictions against blood products, let your doctor know so they can arrange to recycle your own blood. Blood loss differs from patient to patient, and pre-existing conditions such as anemia and other diseases can affect the odds of needing blood after surgery.
As a general rule, major bone surgery is associated with blood loss, but it is impossible to say how much blood a particular patient will lose. If needed, blood transfusions today are very safe and effective.
Preparing for the Return Home
Do I need someone to stay with me after surgery?
If you live alone, an adult friend or relative should stay with you, in addition to the home health nurse visits during the week. For very elderly patients and patients with other health problems, a stay in a rehabilitation unit or a nursing facility may be necessary.
You might consider local home health agencies prior to coming to the hospital. If you have private insurance, you will need to make sure you choose a home health agency contracted with your insurance. The best time to do this is before you have surgery. Ask your doctor about these resources; they can arrange many of these things for you to ensure a smooth transition to your home.
How long do I need someone to stay with me after surgery?
You should plan on about two to four weeks, depending on your individual circumstances and available resources. During the first month, a home health nurse will visit you several times a week. Having someone with you can help with daily activities and chores, even though you will be able to walk and transfer yourself by the time you leave the hospital.
Where can I get a disabled parking sticker?
Your doctor should have forms that allow you to get a temporary disabled parking placard. A permanent disabled placard is not necessary after knee surgery, since the new knee is designed to increase your mobility. Some patients need a few weeks or months of parking in disabled zones, and others do not.
How do I prepare my home for after surgery?
Prior to surgery it is a good idea to take a close look at your home environment to determine if it is “user friendly” for someone on crutches or a walker. Modifications and equipment needs can be addressed ahead of time to ease your return home.
How do I prepare my home for after surgery?
Examine your home environment to see if it is user-friendly for crutches or a walker. Modifications and equipment needs often include the following:
- Remove loose throw rugs, runners, area rugs in pathways. They can get tied up in the wheels of a walker, catch on a crutch tip or slide when stepped on.
- Moving furniture to widen pathways and making sure doors open fully will make it easier for you to navigate with a walker or crutches. Bathroom doors are often too narrow to get through. Your physical therapist will instruct you in a safe technique to use.
- A toilet riser, commode, grab bar on wall, or arm rests that easily attach to a toilet may be helpful as getting up and down may be difficult initially.
- A step-in shower is the easiest to access. Many have seats built right in. If you have a bathtub only or tub/shower combination, a portable shower chair may be necessary for about a month. Having a grab bar is also recommended for optimum safety. Towel racks are not designed to hold the body’s weight and do not replace a grab bar.
- Having at least one rail on stairways to provide support is recommended.
- Night lights are recommended for all pathways used after dark.
- A portable telephone comes in handy when you are alone at home.
Medication Use Before Surgery
Can my doctor fill narcotics medications until my surgery?
Before surgery, your physician can prescribe medications that are non-narcotic and non-addictive. These typically include anti-inflammatory medications and some light narcotic pain medications.
Any addictive drugs, such as narcotic pain-killers, should be obtained from your primary care doctor before surgery. Your primary care doctor and surgical team should be aware of all your medications, especially narcotic medicines.
When, and what medicines, should I stop?
In consultation with anesthesia and the pre-surgical medical consult, you will be advised personally which medications to stop in anticipation of surgery, and when to stop. The following are some general guidelines:
- Ten days before surgery, stop taking blood thinning medications, such as clopidogrel bisulfate, ticlopidine, or aspirin, as well as vitamins, nutritional supplements, herbal supplements, fish oil, and anti-inflammatory medications, such as ibuprofen.
- Five days before surgery, stop taking warfarin. This is a blood thinner that is usually prescribed for conditions such as blood clots, strokes, and irregular heart rhythm.
- Other medications can be continued until the day of surgery. If you are taking steroids, chemotherapy, or medications for rheumatoid arthritis (such as methotrexate), you will be told when to stop those.
- If a medication is not listed here, check with your internist or family doctor. You can also discuss these with your surgeon, the anesthesia staff, or the pre-op staff when you visit the hospital. When in doubt, please e-mail or call.
Should I take vitamins and supplements before surgery?
No, and these should be stopped around 10 days before surgery. Vitamins, herbal supplements, and nutrition supplements can interact with the other medicines we use during surgery, and can lead to excessive bleeding during and after surgery. After knee replacement, patients usually take a blood thinner for around a month. You can resume taking vitamins, supplements, and alternative therapies once you are off the blood thinner.
The Night Before Surgery
What do I need to do the evening before surgery?
The evening before surgery take a shower, but avoid shaving the legs, since this increases the bacterial load.
For your hospital stay, pack a bag with a robe or housecoat that opens in the front; house shoes or comfortable shoes for physical therapy; personal hygiene items; underclothing; glasses or contact lenses with case; dentures or partials with case; a case for hearing aid and spare battery; a walker if you have one; a C-Pap machine if you use one; loose fitting clothing to wear for physical therapy; advance directive if you have one; a list of current medications with dosages; an inhaler if you use one; and reading material, cell phone, and laptop computer if you prefer. The hospital has wireless Internet for your use.
Can I take my medicines the night before surgery?
You should take your blood pressure and heart medications with just a sip of water the morning of surgery. Your medical doctor may advise differently; if so, please follow his or her instructions and let the surgical team know. For example, in some patients, warfarin may be an essential medication safeguarding against stroke. In that case, your surgeon will work with the medical doctor to continue this drug, and alter their surgical preparation accordingly.
The pre-operative visit to the hospital is a good time to take notes and ask questions. Each patient is different; procedures and planning should be customized to your individual needs.
Why might surgery be cancelled at the last minute?
If you have an unexpected health problem, it may be safest to postpone the surgery until the situation is addressed. Let your doctor know if you have any of the following close to your scheduled surgery: symptoms of a cold or flu (chills, fever, or a cough); pain, burning or frequency when you urinate; cuts, scratches, rashes, bug bites, non-healing sores on your skin; new swelling on the leg undergoing surgery; or a change in your medical condition, such as high blood sugar or chest pain. These situations could mean that surgery has to be rescheduled.