HOME PREPARATION

Bathroom

Consider installing grab bars in your bathroom, especially on the walls of the tub or shower stall. Make sure you know how to find wall studs for secure installation. Prior to surgery, make sure that a walker will fit through your bathroom door. Remove any throw rugs to avoid tripping. If you have glass shower doors on your tub, you may want to take them off to accommodate a shower seat. There are two types of shower seats. A tub transfer bench straddles the wall of the tub, and the other type sits inside a shower stall. (A resin porch chair can be used, with a rubber mat underneath to prevent skidding.) With a tub transfer bench, you may need someone to help you lift your operated leg up and over the side of the tub, until you get stronger and can do this yourself. Shower seats are typically supplied by the hospital before discharge and are paid for by your insurance. Consider checking with your insurance company before surgery, to ensure you have this essential piece of equipment when you leave the hospital.

You may want to install a hand-held showerhead, for easy showering while seated. Cheaper models fit right over a tub spout. You can use liquid soap or put a bar of soap into a nylon stocking and tie it to a grab bar. That way, you will avoid the danger of trying to bend in a slippery shower to retrieve a dropped bar of soap. Have a supply of wash clothes in the bathroom for sponge baths, when no one is available to help you shower. You will be able to wash your hair in the kitchen sink alone. Women can tape a razor to a long handled wooden spoon or ruler to shave their legs while seated on the shower seat.

You may benefit from an elevated toilet seat if your regular toilet seat is quite low. See how you do in the hospital. If you have difficulty getting up from the hospital toilet, request a raised toilet seat for home. This item is usually issued at the hospital and paid for by your insurance. Again, you may want to check with your insurance company, before your surgery. Some people permanently replace their toilet with one that has a 17” high bowl.

Seating

Use a comfortable chair post-operatively. Typically, a chair with a higher seat cushion and armrests facilitates getting up from the chair. A straight-backed chair with a seat cushion and armrests is most convenient in the early post-op days. A height-adjustable office chair can work well; but if it has castors, brace it against something before sitting down, to make sure it will not roll out from underneath you. A resin porch chair used with a seat cushion is an inexpensive solution.

Stairs

Your ability to use stairs after surgery will depend on Dr Swanson’s post-operative precautions for you and your own strength. During the early weeks, you may need to lie down and rest several times a day; so, try to have your rest area on the same floor as a bathroom and the kitchen. Some people with two-story homes choose to move their bed downstairs, or to rent a hospital bed and place it downstairs until they feel stronger. Others use an upholstered recliner in which to rest, during the day. If you choose that option, practice before surgery, to be sure you can easily get up out of the chair. Still other patients have found that they can manage stairs several times a day, as long as most of their day is spent on one level.

Cupboards

It may be difficult to reach very low, high, or deeply recessed items, while your knee is healing. Organize one easy-to-reach shelf in your kitchen with the pots you use the most, several dishes, and storage containers. If you do most of the cooking in your home, prepare meals and freeze them before your surgery, or stock up on meals that require little preparation.

Drawers and Closet

Put together a wardrobe of loose, casual clothing that is appropriate for the season and place it in the front of the closet. Rearrange your drawers so that the clothes you will use most often are in the top drawer.

Bed

Check the height of your bed to see if you will be able to manage getting in and out with a newly operated knee. Plan to sleep on the side that will let you have your operated leg on the outside, when you’re on your back. If your bed is too low and too hard to modify, consider renting a hospital bed temporarily. You might also want to treat yourself to a mattress topper or egg-crate foam, for extra comfort.

SELF PREPARATION

Dental Appointments

You should complete any needed dental work several weeks before surgery. An abscessed tooth, neglected teeth, and inflamed gums pose a serious infection hazard for your artificial joint. Likewise, corrective dental work, especially cleaning around the gums, can release bacteria into the blood stream. If these bacteria land on your artificial joint, they can coat it with a scum just like tooth plaque, then infect the surrounding bone. Such infections cannot be cured merely by taking antibiotics. So, get your teeth fixed and cleaned on time, and practice good dental hygiene afterward, according to your dentist’s instructions.

The risk of infection is thought to be greatest during the first two years after total joint surgery. Therefore, the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) recommend that all total joint patients receive a single dose of specific antibiotics an hour before higher-risk dental work—including cleaning—for two years following surgery. Additionally, antibiotics should be taken prior to any manipulation or surgery on your genito-urinary tract or gastro-intestinal tract, and any infection anywhere in your body should be treated promptly with antibiotics. After two years, live tissues with active immune factors have grown onto those surfaces of the implant that touch the bone, and the risk of infection is reduced, although never gone. Continue to practice good dental hygiene, for life. Patients with diabetes or inflammatory arthritis, those who use steroids or immunosuppressant medication, or anyone else prone to infection should use prophylactic antibiotics before dental work for the rest of their lives. Check with Dr. Swanson if you are unsure about your status.

Exercise

Exercise is typically very painful for patients preparing for TKA surgery. However, swimming or gentle exercises in a pool can give you a pleasant, aerobic workout without causing too much discomfort to your knee. In addition, you should practice the exercises you will be doing after surgery.

Grooming

Plan to get any needed haircut shortly before your surgery, because you won’t be able to drive for several weeks post-operatively. Women may want to plan on last-minute leg waxing or shaving. Trim toenails shortly before surgery, as you may have trouble reaching your foot for several weeks after TKA. If you choose to get a pedicure, try to ensure that the shop is careful about sterilizing its instruments.

Sleeping

Adequate sleep during the weeks before surgery is very important. Many people find that anxiety and increased pain caused by ceasing NSAIDs keeps them awake. If you have trouble sleeping you many want to take a sleeping aid like Tylenol PM or Benadryl (diphenhydramine). Tylenol can be used for pain control in lieu of NSAIDs. Check with Dr Swanson or his staff before adding any medications.

Finances

After surgery, your energy and attention span may be low, and you may be unable to concentrate on business for some time. You may want to take care of all of your finances and paperwork before surgery. Pay bills in advance. If you don’t have the money for advance payments, write post-dated checks and write a mailing date on each envelope. Keep some cash on hand, too. That way, if you need to ask a neighbor or friend to pick something up for you at a store, you can pay them back right away. You can even prepare some thank-you notes in advance.

Pet Care

Most pet owners report that their pets were a great source of comfort and companionship post-operatively. However, you may want to make arrangements for someone to help feed them, as it may be difficult to reach bowls on the floor. Likewise, you won’t be able to take them for walks for quite some time. It is helpful to get your pets accustomed to crutches and walkers before surgery.

You will not want them bustling around threatening to knock you over in their enthusiasm to see you again upon your return from the hospital. For your first post-operative meeting with your pets you may want to be seated securely in a stable chair with a pillow between your legs to avoid being jostled. It will not be appropriate for your pets to sleep with you post-operatively. You may want to be sure to shut your door at night to keep them out or rent a hospital bed that is higher. Teach them that this bed is off limits.

To ensure they are not going to knock you over going down the stairs, stop at the top of the stairs and let them proceed down ahead of you.

Dealing with Fear and Anxiety

It is perfectly normal and appropriate to feel fear and anxiety before surgery. Avoid caffeine and stimulants. Make sure you sleep each night, even if you need to take sleeping aids. It is not helpful to lie awake and worry, exhausting your body and mind.

Clothing

Casual clothing that pulls on and off easily over your operated leg is essential. Women may prefer loose dresses or skirts. Make sure trouser legs are baggy enough to accommodate some bandages and post-operative swelling. You can use your reacher to help pull on your clothing, but don’t set yourself up for a daily struggle by wearing tight clothing.

You will need to have a pair of low-heeled, comfortable shoes with non-slip soles to wear post-operatively. They should fit securely and adjust to accommodate any swelling in your foot. You may have trouble reaching far enough to tie your shoes, and you will tire of needing someone to help you. Athletic clogs, athletic sandals, and backless slip-on sneakers are popular choices. Regular lace-up shoes can be fitted with curly elastic laces to become slip-ons. Long handled pliers can be used to pull Velcro straps closed, and long handled shoehorns can be useful. Avoid heels and slippery soles.

What to Take to the Hospital

Don’t over pack for the hospital. Hospitals request that you don’t bring valuables with you, although out-of-town patients may be allowed to deposit items in a safe. You won’t be in any condition to watch over your valuables, nor will you be able to carry them along if you need to leave the room. Give your overnight bag to a friend or family member who can carry it to your hospital room after surgery.

Important items to bring to the hospital include:

· Insurance card or number
· Phone number of insurance and doctor
· Stable shoes for PT and going home
· Loose comfortable clothing for PT and to wear home (sports shorts and T-shirts are good)
· Daily medications, vitamins or laxatives that have been approved by Dr Swanson (let the nursing staff know if you are taking any medications in addition to what they are giving you.)
· Basic grooming supplies—brush, comb, dental supplies, deodorant

Popular items include:

· Phone card for long distance calls
· A cheap watch
· Lip balm for dry lips
· A pillow from home
· Ear plugs and a sleep mask
· Very light reading material
· Disposable Comfort Bath® wipes and No Rinse® shampoo (no water needed)
· Personal music with headphones
· Fanny pack to hold essentials and strap to the hospital bed
· Breath mints or gum
· Socks—grip soles are nice
· Eyeglasses with plain lenses for PT, even if you normally wear a multifocal prescription—plain lenses lessen the chance of tripping, especially when you’re taking narcotics

POST-OPERATIVE CARE

You may be tired post-operatively and require help getting into and out of bed for the first several days after you arrive home. It is very helpful if someone can stay with you during the first week to cook, bring you things, help with TEDs compression stockings, help you shower and shampoo your hair, do laundry, etc. Many people get an intercom, so that they can communicate easily with each other. After the first week, you may need someone to come only for a short period twice a day, to do little things like help with pets and bring in the mail. Churches and charitable organizations often have volunteers willing to assist people after surgery.

You will not be able to clean your house during the early weeks, so plan to get help. The anesthesia will often cause patients to perspire a lot post-operatively so you may find you want to change your bed sheets daily. You may also need to hire a lawn service or dog-walking service. Make a list ahead of time of restaurants and grocers that deliver meals. Some grocers will accept phone-in orders for pick up. This saves time for the person doing your shopping.

Most experienced patients have found that they preferred to be left alone to rest, during the first 2-3 weeks post-operatively. You will need to stick to your PT schedule, you may often feel exhausted, and sitting for long periods of time may be painful and inadvisable. This is not a time to err on the side of being polite. If you have trouble asserting yourself with visitors, make a pact with a family member. Arrange for them to usher visitors out at your signal, or have them help you excuse yourself to go rest. Your comrade can encourage well wishers to send cooked meals for the family and return to visit starting at three weeks post-op. By then, you will be feeling much stronger, able to sit for longer periods, and ready for some diversion from the monotony.

Most insurance companies will allow you to have in-home health care. These nurses and aides can assist you with showering and incision care. Taking your first shower may be challenging and unnerving and require competent help. Dr. Swanson routinely discharges patients with orders for home healthcare nursing and physical therapy.

You will sleep better at night if you haven’t spent the whole day in bed. Be sure to have a change of scenery. Get up and move about regularly and reserve bed for naps and times you just cannot get comfortable anywhere else. Get some fresh air on a suitable chair outdoors, if the season allows. You may find you sleep better if you aren’t sharing a bed, on guard against your partner bumping your leg. Likewise, your usual bed partner may sleep better—and help you more effectively during the day—if he or she isn’t on alert, listening to you rustling about trying to get comfortable.

Once the incision is completely healed (usually around 4 weeks after surgery), you may begin working on massaging your knee with hand lotion, vitamin E, or topical ointments (like Flexall, Aspercream, or BenGay) to soften scar tissue (avoid topical ointments which are irritating or burn). An anti-inflammatory (such as Advil, Aleve, Motrin, etc.) also helps with swelling and inflammation. Sleep with the knee brace in place to prevent the knee from healing in a permanently flexed (bent) position until 6 weeks after surgery.

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