UniSpacer™ Replacement Surgery
1. Before Surgery
You may need to have a few preadmission tests done in the weeks prior to your surgery. These tests may include blood tests, a urine sample, an EKG, and a chest x-ray, depending upon your age and health. These tests may be performed either at the hospital or another testing site such as your primary care physician’s office.
You may also be scheduled to speak to an Anesthesiologist about the anesthesia you are to receive during surgery, or about any problems you have had with anesthesia in the past. You also may be asked by your surgeon or the Anesthesiologist to see your primary care physician or a specialist for clearance to proceed with your surgery. The purpose of this testing and the visits with these physicians is to ensure that you are mentally and physically prepared for your surgery.
When you are scheduled to go to the hospital or surgery center for testing or for surgery, please make sure that you take with you all of the papers pertaining to your surgery given to you by your doctor’s office, your insurance cards, and a list of the medications you take and any allergies you may have. A written or typed medical history of all prior surgeries and illnesses would also be helpful.
Fasting
Your doctor’s office will give you specific instructions about fasting
before surgery. Typically, patients are told not to eat or drink anything
after midnight the day before surgery.
What to Wear
Wear
comfortable clothing to the hospital. Do not wear any makeup or nail polish.
Medications
If you are on medications, you should have received instructions about which medications you should take the morning of your surgery.
If you have any further questions about whether or not your medications should be taken the morning of surgery, please ask the nurse or contact your doctor’s office.
2. Preparing for the Operating Room
You will be asked to arrive approximately 90 minutes before your time of surgery to make preparations for your operation. Refer to your hospital booklet for specific instructions concerning the admissions process.
Upon arrival at the preoperative area you will be asked to change into a hospital gown. Any friends or family who accompany you will be allowed to stay with you during this period of time.
Approximately one-half hour before the time of your surgery, you will be transferred to the “holding area” for final preparation. An intravenous line (IV) may be placed in your hand or arm. The nurse may use a local anesthetic to reduce the discomfort of IV placement. You will receive medications and fluids through this IV The IV will stay in until you are able to drink liquids without any problems and you no longer need it for medications.
The skin around your knee may need to be shaved in preparation for the surgery.
In the “holding area” the nurses will ask you additional questions related to your health in preparation for surgery. Many of the questions will be asked multiple times and will appear redundant. Please be patient! It is important that we double and triple check certain points to insure the highest quality of care.
Your anesthesiologist will be meeting with you and may repeat several questions related to your general health and history of anesthesia. If you have any concerns or questions about anesthesia, you may certainly voice them at this time.
Your surgeon will also meet with you in the holding area and answer any last
minute questions you may have.
You may be given a medication to help
you relax and reduce any anxieties you may have.
The nursing staff will take your temperature, blood pressure, pulse and respiration. You may be instructed on certain breathing techniques to use when you wake up after surgery. The nurses may put a special type of stocking on the leg that will not be operated on.
Your family and friends will be given instructions about where to wait. You will then be taken to the operating suite.
3. Once in the Operating Room
When you arrive in the operating room there will be several people to assist you during this stage of your surgery. A nurse will be in scrubs, a hat, and a mask. He or she will probably be one of the people that come and take you from the waiting area to the operating suite.
The anesthesiologist or nurse anesthetist will be administrating your anesthesia during the procedure. They will be positioned near your head during the operation. They will also be wearing scrubs, hats, and mask.
You will be transferred from your bed to the operating room table. The room will probably be very cold but you will be given blankets to keep you warm.
You will be given either a general anesthesia, which makes you unconscious, or a regional anesthesia to numb the area to be operated on. Patients who receive regional anesthesia may also be given sedatives to put them to sleep. The decision as to which type of anesthesia to use is made by the surgeon and the anesthesiologist and is based on a variety of factors, including your health. In either case, you should not feel any pain during surgery. Once you are anesthetized, your body and legs will be positioned in the proper place to optimize the surgical exposure.
To control blood flow, the surgeon may place a tourniquet on your upper thigh to restrict the blood flow to the knee during the procedure.
A nurse will then prep your leg with a special solution that disinfects and cleans the area around the incision site. Once the area has been prepped, the surgeon and surgical assistant will then drape your leg and body with special sheets that are sterile and liquid resistant.
4. After Surgery
You will be taken to the recovery room immediately after your surgery. In the recovery room, another team of nurses will take care of you. An oxygen mask may be placed on your face to aid your breathing. Your doctor may order x-rays of your knee.
When your blood pressure, temperature, pulse, and respiration return to normal, you will be moved to a regular hospital room, sometimes in an area with other orthopedic patients and specially trained nurses. Here, several people will be involved in your care, including a nurse and possibly a respiratory therapist to show you some breathing exercises.
Once you are in your room, your nurse and his or her assistants will check on you frequently. They will help you find the most comfortable position and will give you a button to push if you need assistance from the staff. P lease do not try to get out of bed yourself. Your pulse and blood pressure will be monitored frequently.
Your surgical team will be visiting you on a regular basis.
Pain Medication
You can expect some pain and discomfort after surgery. Your doctor will order pain medication for you. Let the nurse know if you are having any discomfort. Please take the pain medication when you need it because it will help you to rest comfortably and help you perform your physical therapy more effectively. Both rest and physical therapy are important for your recovery.
Intravenous Lines
You will have an intravenous line in your arm or hand so that you may receive IV fluids, antibiotics, and possibly pain medications.
Wound Care
When you awaken from anesthesia, you will find a large bulky dressing on your leg. When the large bulky dressing is removed, a smaller one will be applied so you will be able to shower. You will have an incision on the front of your knee approximately 2-3 inches long. You may have a knee brace on your leg after surgery. Your physician will instruct you as to how long you will need to use this.
Medications
Your physician may ask you to take medication during your recovery to help prevent blood clots. You will also receive antibiotics through your IV while you are in the hospital.
TED Hose
You will be asked to wear white elastic stockings (TED Hose) on your legs following surgery. The purpose of these stockings is to help prevent blood clots from forming in your legs. You should continue to wear these stockings during your hospitalization and also after discharge, until your doctor tells you that you can remove them. You may remove them daily for bathing only and then please reapply them.
Temperature
A low grade temperature (up to 101 degrees) may be present for up to one week. This elevation in temperature is usually due either to the breakdown of red blood cells in your swollen knee or to phlegm collected in your lungs.
Exercises and Activity
You will be assisted in getting out of bed either on the day of surgery or the first day after surgery. Your postoperative exercise program will be tailored to your needs by your physician. You will be given specific instructions by your physician as to what type of physical therapy you may need.
5. Recovery
The Next Day
Physical Therapists will visit you to start your rehabilitation program. Every doctor uses a different rehabilitation protocol, but typically you’ll be standing up and walking the day after surgery.
Physical therapy is very important for your recovery. It helps you regain the activities of daily living and speeds your recovery.
During your physical therapy, you may be asked to perform the exercises you learned before surgery along with new exercises. Initially, you may use crutches to aid your stability in walking.
Your progress and success are a direct result of your participation in your therapy. Usually by four to six weeks, most people are walking with no or little aid.
Care of Your Incision
If you have persistent drainage from your knee, please change the dressing to a clean, dry dressing. Once your incision is no longer draining, you may wash it with soap and water while you shower. Avoid soaking your knee in bath water until your surgeon gives approval.
You may no longer need a dressing over the wound if it is not draining. Continue wearing your knee immobilizer or brace until you are instructed that you no longer need it.
Knee Brace
You may be given a knee brace to wear to protect your knee during the first two weeks of recovery. It is important that you keep your brace on at all times and follow the instructions of your surgeon. You will be allowed to take the brace off to bathe and exercise.
Continuous Passive Motion (CPM) Machine
You may be asked to begin using a CPM immediately after your surgery. The CPM will help you maintain and improve the range of motion of your knee. Your surgeon or nurse will give you specific instructions for using the CPM. You will likely be asked to use the CPM several hours a day for the first two weeks after surgery.
Medication
Most patients experience pain after knee surgery. Depending on your tolerance, your doctor may prescribe painkillers. Some doctors recommend coated aspirin during the post-op period for its mild blood-thinning properties.
It is extremely important that you consult with your doctor before taking any drugs or medication.
The Recovery Period
Most patients have some temporary pain in the knee because the surrounding muscles are weak from inactivity and the tissues are healing. Surgical soreness and swelling may take several weeks to subside, however, within a few months you should be able to return to your normal activities.
6. When to Call Your Doctor
Following your doctor’s instructions will go a long way toward reducing your chances of complications. Problems, however, may still arise. You should let your doctor know right away if there are any changes around your incision.
Also call your doctor immediately if you have:
- Fever above 101 degrees F.
- Persistent swelling or redness
- Increased bleeding, drainage or foul odor from the wound
- Increased pain or swelling in your knee or lower leg
7. Possible Complications
Although every precaution is taken to ensure a successful outcome, any surgery involves possible risks:
Anesthesia: Your anesthesiologist will explain the risks associated with anesthesia and the precautions that are taken.
Infection: Infection is a risk associated with any surgical procedure, however in a healthy person it is rare. Your care team will monitor you closely for any signs of fever. Also, you should call your surgeon immediately if you develop a fever once released from the hospital.
Blood clots: There is a risk of developing a blood clot during or right after surgery, which can be a serious condition. However, in most cases the blood clots are minor and can be managed with anticoagulants - drugs that thin the blood and prevent clotting. Call your surgeon at once if you develop significant calf pain or swelling.
Other risks include scarring, numbness around the surgical site (which usually resolves over time) and weakness in the knee if the patient does not complete sufficient amounts of physical therapy after the operation.
There may be other potential complications related to the device that your surgeon will discuss with you prior to surgery.
8. Living with Your New Knee
Taking good care of yours knee in the months following surgery is crucial for optimal recovery.
Here are some general guidelines for knee replacement patients. Since each patient is different, it is very important that you ask your care team for specific instructions relating to your particular condition.
Driving
You should not drive a car until cleared by your doctor, typically a few weeks after surgery. This is a safety precaution since you probably won’t have the needed leg control right after surgery to work the gas and brake safely.
Traveling
Most patients are permitted to leave the house as long as they feel well enough to do so. Out-of-town travel requires special consideration as to safety, rehabilitation activities, and follow-up appointments.
Diet
Typically there are no special diet restrictions. Make sure you eat plenty of fruits and vegetables and drink six to eight glasses of water a day to prevent constipation and straining your joints. Iron supplements may be recommended to restore strength.
Sexual Activities
Generally, doctors advise that patients can resume sexual activities whenever they feel able. It is best to modify your positioning to keep pressure off the knee incision until it is healed and is no longer tender.
Exercise
Your knee may feel stiff at first, but an exercise program supervised by your therapist can help you build strength and increase your range of motion.
As far as sports are concerned, it’s usually okay to walk, swim, play golf and bicycle; but avoid sports that repeatedly jar the knee joint such as tennis and jogging. Discuss exercise options and alternatives with your doctor.
