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Preparing for Knee Replacement Surgery

You have a very important role in preparing for surgery. It is important to follow the instructions so that your surgery will proceed as planned. Follow the directions given to you by your Doctor as well as the information provided to you in the Total Joint or Accelerated Recovery Program for Orthopedics (ARPO) class. If you have any questions, feel free to contact your Doctor’s office for guidance.

Pre Admission:

  • Visit primary care MD for History and Physical. Form should list Past Medical History, current Medication (herbals and over the counter) with dosage and time of day they are taken and Past Surgical History.
  • Pre Admission Testing
    • EKG - test done to check heart rhythm
    • Chest x-ray - to make sure there is no infection or disease process in the chest cavity
    • MRSA swab - to make sure you do not have this type of infection
    • Labs within 7 days of surgery - to check normal blood levels.
  • The focus of the program is to get you home as soon as possible. A small number of patients will require rehab after surgery. Feel free to explore rehab facilities and have a list of 5 of your preferred facilities to give to your discharge planner.
  • You will need to stop your Aspirin, Coumadin, Naproxen and Ibuprofen 1 week prior to your surgery unless given direction from your MD stating otherwise.
  • Do not shave your legs for one week prior to surgery.
  • The evening before surgery, fast from midnight—no meds (unless otherwise directed by your MD), no food/drinks, may brush teeth—swish and spit, don’t swallow.
  • You will cleanse the area to be operated on the evening prior to surgery with antibacterial wipes given to you in pre-admission testing.

Day of Surgery

  • Fast from midnight - no meds (unless otherwise directed by your MD), no food/drink, may brush teeth - swish and spit, don’t swallow.
  • At the St. Elizabeth Campus, park on the 2nd level of parking garage, outpatient. Procedure parking blue-gray border. Enter through walkway into 4th floor of hospital; check in at admission desk to your immediate left.

Pre-Op Area

  • Name bracelet, IV, 1st dose of antibiotics, scrub area; we will not shave the area/leg prior to surgery.
  • Sign 3 Consents - Surgical, blood, and anesthesia
    • Surgical - procedure, MD will write on the leg receiving surgery. Patient will sign consent, MD will sign consent, Nurse will witness signatures.
    • Blood - nonautologous (donor bank blood) or autologous (own blood donation) or refusal to receive a blood transfusion.
    • Anesthesia - General or Spinal. Anesthesiologist will speak directly to patient that morning. Usually do spinal anesthetic; with some general anesthetic, the patient will be asleep.

Operating Room

  • Procedure takes an hour to hour and a half. MD will speak to family once patient is in Recovery Room. Family can then go to the 2nd floor Orthopedic waiting room until the patient arrives from the Recovery Room and is settled in his or her room by our nursing staff.
  • Patient will stay in Recovery Room for 30 minutes or longer, depending on bed availability and pain control.


  • Early surgeries: the patient will dangle legs on the side of the bed, walk with therapy, or be out of bed with nursing staff the day of surgery. Late surgeries will at least dangle legs at the side of the bed with a nurse present.
  • If patient cannot urinate after 6-8 hours, the nurses will scan the patient’s bladder. We have orders to insert a urinary catheter overnight if the patient is unable to void.

Post-op Day 1, if in hospital

Discontinue urinary catheter, knee drain, PCA (pain pump) in a.m., if applicable. Start oral pain medication. Be sure to know your medication schedule and when you can take them. Pain scale 0-10, pre-medicate prior to therapy. PT/OT twice a day.

Post-op Day 2, if in hospital

Dressing change and shower. You may bring shampoo and soap, or shower cap if you don’t want to get your hair wet.

Post-op Day 3, if in hospital

Discharge to home or rehab. In discussion with your discharge planner, you will be aware of transfer time and destination if you are discharged to a rehab facility.

Nursing Equipment

  • CPM (continuous passive motion machine) – Only for Dr. Dennison’s knee patients. Dr. Wickline’s patients may need this machine if they are unable to bend the knee to his expectations.
  • Incentive Spirometer (deep breathing machine) – 10 times an hour helps prevent pneumonia.
  • SCDs (leg pumps) – On at all times while in bed; help prevent blood clots.
  • Anticoagulants (blood thinners) – Medication that helps prevent blood clots. When you are discharged, your healthcare team members will teach you how to take your anticoagulant medication on your own. 
  • Expect to be out of bed at least three times a day, especially out of bed to the bathroom.

Possible Complications

  • Confusion
  • Blood clots
  • Pneumonia
  • Infection - Antibiotics when you have dental work. Check with your Doctor to see how long you will need these.