Hi, thank you for selecting HSS and placing your trust in my care for total knee replacement. My name is Doctor Cynthia Kahlenberg and I look forward to performing your surgery. My team and I are here to guide you through this process.

 

In this video I am going to review the most common questions regarding your surgery and review what to expect leading up to surgery. If any questions are still unanswered, please feel free to contact my office for further clarification.

 

You have gotten through the first step of meeting me and my team. At your visit, you should have received a white HSS folder with some important information regarding surgery. If you do not have the folder, each of the documents are linked in the blue button below this video. These documents go through important details of the surgery including: all important contact numbers, what to expect, risks and benefits of the surgery, as well as frequently asked questions. We highly encourage patients to take the time to read through these documents in detail to gain a better understanding of the surgery.

 

Here we are showing a representative model of a knee replacement. A knee replacement involves a metal cap on the femur bone, a metal cap on the tibia bone, and a plastic insert. Most implants are made of oxinium or cobalt chrome on the femur side, titanium on the tibia side, and a polyethylene insert.

 

An x-ray of knee arthritis looks something like the top image. After knee replacement surgery, the xrays looks something like the bottom image.

 

In preparation for knee replacement surgery, we highly encourage the purchase or rental of an ice machine which will aid in your recovery. Most patients use the ice machine for at least the first 2 to 3 weeks after surgery, but many use it for 6 weeks. Please click the link below this video for the ice machine to buy or rent from the HSS vendor.

 

It is important to review the page in the preoperative packet, which is linked below, that explains limitations of knee replacement surgery. I want to remind you that this is not going to feel exactly like the knee that you had when you were 20 and is unlikely to ever feel exactly like a normal knee. It is common for knee replacements to click, some patients report a tightness or band like sensation after surgery, some report numbness on the outer aspect of the knee, and many patients say it is uncomfortable to kneel on a knee replacement even several years after it is done. These implants are not designed to make you a better pickle ball player, rock climber, runner, golf player, etc., but are really designed to help you walk better and perform daily activities with less pain. Knee replacement surgery requires your commitment and can take up to a year for full recovery. Some patients see continued improvements up to 3 years post-operatively.

 

A pre-operative clearance will be scheduled by our office and you will be sent an email with the details. If your surgery is at Stamford Hospital, you will go to the Tully Center in Stamford for your preoperative visit and if your surgery is in New York City, you will be going to New York for the visit. At this visit, you will meet with one of our preoperative internists who will evaluate you to optimize your health in preparation for the surgery. At this visit, you will also undergo any preoperative imaging that is necessary for surgery and will meet with a physical therapist who will go over some of the physical therapy considerations for after the surgery. This prep appointment entails blood work, review of medications, imaging and further testing if needed. You do NOT need to fast in preparation for this visit. In particular, the preoperative internist will tell you which medications to continue, and which medications to stop in preparation for the surgery. You do not need to go to your primary care provider but we would recommend informing them of the upcoming surgery. If you regularly see any specialty doctors such as Cardiologists, hematologists, neurologists, vascular etc. we would recommend you seeing them for clearance for this surgery.

 

You will be called the day before surgery by operating room staff to indicate what time to arrive at the hospital for surgery as well as when to officially stop eating or drinking. It is very important to be on stand-by for this call. If surgery is scheduled for a Monday, you will receive a call on the Friday before. Please keep in mind, the timing and order of your surgery is decided by the OR schedulers and we are unable to guarantee a specific time for your operation.

 

Once you arrive at the hospital, you will be taken to the preoperative area where the nurses and PA’s will start prepping you for surgery. You will be seen by myself and the anesthesiologist prior to surgery. The surgery will take approximately 2 hours. Most patients are able to go home the same day as the surgery, but some patients stay overnight in the hospital for medical monitoring.

 

You will meet with a case manager prior to discharge who will arrange for a home physical therapist to come to your home 2 to 3 times per week for the first 2 weeks after surgery. You will also be given discharge instructions which will go into details of which medications you will be taking.

 

You will walk and work with a physical therapist prior to being discharged from the hospital. You will most likely be ambulating with a walker out of the hospital for the initial period after surgery. Once stable enough, you will be able to progress to the cane and eventually to no assistive device. The hospital will provide you a walker if you don’t already have one.

 

You may shower when you get home from the hospital. Your bandage is water resistant but please do not submerge the incision in any pool or bath until being seen at your 6 week post-op visit. You will be given a prescription for pain medications, anti-nausea medications, and stool softener medications. All these items will be reviewed with you upon discharge with either a PA or nurse. You can expect bruising and swelling of the entire leg, which typically worsens in the first 1 to 2 weeks after surgery. We recommend frequent icing as well as elevation to help decrease swelling.

 

You will have a physical therapist come to your home two times per week for the first 2 weeks after surgery. Once you have completed the 2 weeks of home PT, you will transition to outpatient PT. Please call my office to let us know which physical therapy location you have chosen so that we can fax them a prescription for outpatient PT.

 

You will receive a phone call from my team 2 weeks after surgery to check in on your progress. You will see us in person for xray and evaluation in the office 6 weeks after surgery. Please call the office before then with any questions or concerns.

 

It is important to remember that joint replacement surgery is a stress on the entire body, and it is very common after this surgery for the rest of your body to feel the strain of surgery such as your back, the rest of your leg, or your opposite leg. It is important to give yourself time to heal and not to rush the recovery after the surgery.

 

Our nurse practitioner Ashley will now review some very common questions that come up with knee replacement surgery.

 

Can I expect swelling and bruising after surgery? 

Yes, swelling and bruising of the entire leg including the foot are normal for the first 6 to 8 weeks post operatively. The bruising and swelling should improve over time.

 

How long will I be on blood thinners for? Six weeks, unless indicated differently. This usually consists of either aspirin, eliquis, or xaralto.

 

When can I have dental cleaning or dental work? We ask for you to refrain from having any dental work for 2 weeks before and 3 months after the surgery, unless you have a dental emergency. After your joint replacement you will take antibiotics 1 hour prior to every dental appointment for the first 2 years after surgery.

 

When can I go swimming? Please refrain from swimming or submerging your incision under water in a pool, bath, or hot tub until after your 6 week visit.

 

Will I be going home after the surgery? Most patients do go home the same day but some patients stay overnight for medical monitoring.

 

When will I be able to walk or go up and down stairs? The same day of surgery you will be able to get up and walk. Most patients will start with a walker or cane. You will be able to walk up and down stairs when arriving home, with assistance.

 

When will I be able to drive? You are cleared to drive when you are fully off narcotic medications and you feel comfortable with your reaction speed for driving. This is typically around the 4 week mark.

 

How long will I have my bandage or dressing on? You may remove your silver dressing 7 days after surgery. You will then notice a white surgical tape which should stay in place and be removed 14 days after the surgery date.

 

When can I return to work? Most patients return to a desk job within 3 to 5 weeks. For jobs that are more labor intensive, please discuss with us. Please send any disability paperwork to our office and please allow a 7 to 10 day return for all disability paperwork.

 

When can I fly on an airplane after surgery? You are cleared to fly on an airplane at 6 weeks after surgery. If you need to fly sooner, please call the office to discuss. Many patients ask if their new joint will set off the metal detector at the airport. In many cases with only 1 joint replacement, it does not set it off but we recommend that you tell the TSA officer that you have a joint replacement during the screening process. No special documentation is needed for airport security.

 

When can I get routine vaccines? We recommend that you avoid getting vaccines in the 2 weeks before and 6 weeks after surgery.

 

Thank you for your attention, I hope we were able to answer your questions and provide you with helpful information regarding your upcoming joint replacement surgery. We look forward to taking care of you and hope to soon be able to restore your function and minimize your discomfort. Again, thank you for your attention.