{"id":1400,"date":"2021-05-27T01:30:41","date_gmt":"2021-05-27T01:30:41","guid":{"rendered":"https:\/\/drkimball.com\/?page_id=1400"},"modified":"2023-12-06T03:29:16","modified_gmt":"2023-12-06T03:29:16","slug":"knee","status":"publish","type":"page","link":"https:\/\/drkimball.com\/knee\/","title":{"rendered":"Knee"},"content":{"rendered":"\t\t
After undergoing Total Knee Replacement:\u00a0 These are some of the important directions to be aware of:<\/b><\/p>
Dr. Kirt Kimball Total Knee Discharge Instructions<\/b><\/p>
The following discharge instructions are from specific from Dr. Kimball.\u00a0 These instructions are general guidelines.\u00a0 Your individual needs may vary depending on your condition.\u00a0 Please contact Dr. Kimball\u2019s office for more information if needed.<\/b><\/p>
Blood Clot Prevention:<\/b><\/p>
You have been prescribed a medication (Aspirin, Eliquis, Xeralto, Lovenox, or Warfarin) to help reduce your risk of getting a blood clot. It is important you take this as prescribed for the duration of the prescription. Along with taking your other medication, movement is one of the best ways to prevent blood clots. Continue to do ankle pumps while laying and sitting. Walk every 1-2 hours throughout the day, while awake.\u00a0<\/span><\/p> Signs of a blood clot:<\/span><\/p> Managing Pain, Discomfort, and Side Effects:<\/b><\/p> You are going to experience a fair amount of pain. You have been prescribed medication to help in the management of pain and inflammation.\u00a0 Getting pain relief will help you rest better and do important exercises so your new joint will heal properly.\u00a0 Follow the instructions on the prescription label and track the use of your pain medication in a log.\u00a0 It is important to remember to take pain medication before activity and bedtime.\u00a0 When your pain has been controlled, you may slowly decrease the amount of medication you are taking (such as \u2013 taking one tablet instead of two; or increase the time between doses).\u00a0 Narcotics should be the first medication you taper off.\u00a0 Only take the medications prescribed in addition to your regular medications for other medical conditions (ie. Hypertension\/diabetes\/etc) \u00a0 If your medication is not effectively managing your pain, please try:<\/span><\/p> DO NOT<\/b> drive or consume alcoholic beverages while on narcotics.\u00a0\u00a0<\/span><\/p> Pain Medication Refills:<\/b>\u00a0 keep track of pain medication quantity. You must give the office <\/span>24-hour advanced notice<\/b> before you will run out of medication.\u00a0 Make sure to plan ahead, especially for weekends and holidays, as it is difficult for your surgeon to prescribe medications afterhours. Have your medication and pharmacy information ready when you call.\u00a0 Current State Law severely restricts all physician\u2019s ability to prescribe pain medication in an attempt to curtail opioid addition.\u00a0 Although well intended, these restrictions sometimes make it difficult to take care of patient\u2019s needs.\u00a0<\/span><\/p> Constipation<\/b> is a common side effect of opioid pain medication.\u00a0 Continue taking stool softeners and follow the <\/span>Step by Step Bowel Care Guide for After Surgery<\/b>.\u00a0 It is a great resource to help prevent or manage constipation.\u00a0 If you have not had a bowel movement within 7 days, please contact your surgeon.\u00a0 Stop stool softeners if you begin to have loose stool or diarrhea.<\/span><\/p> Nausea<\/b> can be a side effect of pain medication.\u00a0 Make sure to eat something before taking pain medications to help decrease the risk of nausea.\u00a0 If you are experiencing nausea, start refueling your body by drinking small amounts of clear liquids such as 100% fruit juice or broths.\u00a0 Bland carbohydrates are easy to digest and will typically not aggravate the stomach when you are feeling nauseated.\u00a0 Carbohydrate options include crackers, bread, bananas, applesauce, or Jell-O.\u00a0 It is my routine to prescribe an anti-nausea medication in anticipation of this possibility.\u00a0\u00a0<\/span><\/p> Mild dizziness<\/b> is a common side effect of pain medication.\u00a0 Be careful as you walk or climb stairs. Notify your surgeon if the dizziness persists and it is keeping you from walking and being active.<\/span><\/p> Breathing deeply<\/b> will help prevent a respiratory infection following surgery.\u00a0 Take deep breaths every hour until you are back to your usual level of activity. If you were sent home with an Incentive Spirometer, use it 10 times each hour while you are awake and you follow-up with your surgeon.\u00a0<\/span><\/p> Incision Care:<\/b><\/p> With any surgery, there is risk of infection. You can take action to minimize this risk.\u00a0 Good handwashing is the most important thing you \u2013 and those who care for you \u2013 can do to prevent infection.\u00a0 Wash your hands before you touch the area where your surgery was done.\u00a0 Please keep dogs, cats or other pets away during your recovery.\u00a0 They represent a significant source of bacteria that can cause infection.\u00a0 Take extra precautions in keeping bedding and bed clothing extra clean and especially away from pets or other sources of contamination.\u00a0<\/span><\/p> Knee Surgery<\/b><\/p> Your incision will be covered with a waterproof dressing and covered with an ACE elastic bandage when you go home.\u00a0 You may remove the ACE elastic wrap <\/span>24 hours<\/b> after your surgery to shower. It\u2019s okay to let water and soap run across the waterproof dressing.\u00a0 Rinse clean and pat dry. Rewrap leg with ACE elastic bandage to help with compression. No lotions, ointments or creams, should be placed on or around the surgical site or dressing. No soaking or submerging in water such as hot tubs, bathtubs, swimming pools, for 4-6 weeks or until the wound is completely healed and no scabs are present.\u00a0<\/span><\/p> You can expect to have some redness and warmth around the incision site and swelling extending above and below the joint. Bruising and discoloration around your operation site is normal.<\/b><\/p> Change your dressing if the edges become loose and water seeps into it while showering. Some drainage is normal and can be expected. If your dressing becomes saturated and there are multiple large dark spots migrating to the edges of the dressing, then you need to change your dressing. Using the ACE bandage for compression can help slow the bleeding and drainage. The drainage should slow down and stop within 24-48 hours. If the drainage persists, or you notice a significant increase in redness or warmth, please call your surgeons office immediately.\u00a0 In most cases, your original water proof dressing is still in place when you see Dr. Kimball at your first post op office visit.\u00a0\u00a0<\/span><\/p> Swelling:<\/b><\/p> Swelling is to be expected after a joint replacement.\u00a0 It can cause increased pain and limit your range of motion. \u00a0 Swelling is best controlled by following the R.I.C.E. Method:<\/span><\/p> REST<\/b> – Getting enough rest will help your body heal and reduce swelling.<\/span><\/p> ICE<\/b> \u2013 It is recommended to apply ice for 20-30 minutes every 1-2 hours, after physical therapy\/activity, and before you go to bed.\u00a0 Ice can help to reduce and minimize the internal scarring process. Always make sure there is a something between your skin and the ice to help prevent an ice burn. Place ice packs on the outside of your clothes, or place ice packs inside of a clean pillowcase or dish towel before applying it to your joint.\u00a0\u00a0<\/span><\/p> Compression<\/b> \u2013 Using an elastic bandage or compression stockings keeps extra fluid from collecting in and around your joints. You will be using an ACE wrap to help dress your knee incision. This will help with swelling. This should be snug but not too tight. The ACE wrap should be changed daily in order to check your skin and can be hand washed with a mild detergent and hung up to dry if it becomes soiled.<\/span><\/p> Elevate<\/b> \u2013 Several times a day, elevate your leg ABOVE the level of your heart.\u00a0 You may use pillows to elevate the leg. Place the pillows long ways starting just below the knee going towards your heel.\u00a0 If you are doing your exercises to stretch the knee flat, it is ok if a pillow is placed under your knee for limited amounts of time.<\/span><\/p> Diet:<\/b><\/p> Eating high quality sources of protein will aid in wound healing and help to prevent muscle loss during the recovery process.\u00a0 Examples of quality protein:\u00a0 cottage cheese, yogurt, beans\/lentils, salmon, chicken or other lean meats, eggs, and nuts\/nut butters.\u00a0 Eating fruits, vegetables, nuts, and whole grains will help prevent constipation.\u00a0 Drinking plenty of fluids will keep you well hydrated and help to prevent constipation.\u00a0 Forte Post Op (Forteelements.com) is an excellent source for the nutritional elements needed to facilitate recovery.\u00a0 Otherwise protein supplements, Vitamin C, Lysine, Vitamin D and a multivitamin have been shown to facilitate recovery.\u00a0\u00a0<\/span><\/p> Activity:<\/b><\/p> Your physical therapist has created an exercise plan to strengthen and retrain your muscles as you get used to using your new joint..\u00a0 A consistent effort is important. Avoid overdoing it in any single therapy session. Assistive devices (walker, crutches) are mandatory until your strength and balance have returned and you are no longer limping.\u00a0 You will be scheduled to begin Out Patient physical therapy within a few days following your surgery.\u00a0 In some cases, a home health nurse and physical therapist may come to your home during the first week following surgery.\u00a0<\/span><\/p> Frequent, short walks are the key to a successful recovery. It is recommended that you stand and move around every 1-2 hours during the waking hours of the day. Increase your activity gradually.\u00a0 A balance between activity and rest is necessary.<\/span><\/p> You may have difficulty sleeping at night due to discomfort in the operative extremity.\u00a0 Getting up and moving can help to alleviate the discomfort.\u00a0 Problems sleeping is usually not due to a sleep disorder and sleeping medication is usually not appropriate.\u00a0 More effective pain management should lead to better sleep.\u00a0 As an alternative, Tylenol PM is a safe sleeping aid.\u00a0\u00a0<\/span><\/p> Please call Dr. Kimball at 801-373-7350 for any of the following:<\/b><\/p> *<\/span><\/i>There is an answering service available 24\/7, 365 days a year.\u00a0 A medical team member <\/span><\/i>will<\/i><\/b> return your call.<\/span><\/i><\/p> Call your Primary Care Physician for any of the following:<\/b><\/p> RETURN to ER for the following:<\/b><\/p> \u00a0<\/p> Total Knee Replacement (Total Knee Arthroplasty- TKA):<\/b> surgery is done to replace the damaged joint with artificial surfaces. Even under the best of circumstances surgery cannot return the joint to its normal state. However, an artificial joint will likely diminish pain and improve functionality and is designed to improve your quality of life.\u00a0<\/span><\/p> \u00a0<\/p> Timing of the surgery<\/b>:<\/b><\/p> \u201cWhen should I have my knee replaced?\u201d This is a common question and the answer is patient- specific.\u00a0 It varies from patient to patient and is based on a number of variables.<\/span><\/p> Sometimes, even in the presence of minimal pain, it is appropriate to do a knee replacement because <\/span>a deformity is rapidly progressing<\/b>, <\/span>or range of motion is deteriorating<\/b>. This is something we can discuss together so that you can make the best-informed decision.\u00a0<\/span><\/p> \u00a0<\/p> With few exceptions, I tell patients that they should have the surgery when they are ready. I generally will not tell patients to do it or when to do it, but rather wait for them to tell me that they want to proceed\u00a0<\/span><\/p> \u00a0<\/p> Component selection<\/b>:<\/b><\/p> There are several companies that manufacture the hardware used in a Total Knee Replacement.\u00a0 There are a number of variables to consider:<\/span><\/p> Knees are available in two basic designs: <\/span>Standard or what I call \u201coff-the-shelf\u201d knees and \u201cPatient specific Knees\u201d.<\/b><\/p> \u00a0<\/p> \u201cOff-the-Shelf<\/b>\u201d knees have been in production for the approximately 40 years of course with some significant improvements over the years.\u00a0 Examples include such companies as Stryker, Zimmer, J&J, Wright Medical, ODC, Medacta and Biomet to name a few.<\/span><\/p> \u00a0<\/p> How to perform an \u201coff-the-shelf\u201d (OTF) knee: In<\/b> brief, the surgeon opens of your knee, cuts off the ends of the bones and selects a size (usually 1-6) that seems to fit best.\u00a0 The implants are usually cemented in place and the incision is closed.\u00a0 When looking at long-term outcome studies of \u201coff-the-shelf\u201d knees about 75% of patients like their result but about 25% don\u2019t like them even though properly done. OTF knees all have a \u201cgeneric\u201d shape or design.\u00a0 The human knee however varies significantly in size, shape and geometry.\u00a0 When looking at the almost 25% of patients that don\u2019t like their end result some are due to the components being too big, too small or substantially different in design from your native knee.\u00a0\u00a0<\/span><\/p> \u00a0<\/p> P<\/span>atient Specific Knee:\u00a0 <\/b>\u00a0ConforMIS, a small, Boston base company owns the patents to actually create artificial joints specific to the patient.\u00a0 The process is quite unique.\u00a0 A CT scan is obtained including the hip, knee and ankle. From that data a virtual replica of the knee is created from which the implants are designed to replicate not only the size but also the shape of your knee.\u00a0 Alignment of the components is corrected using computer navigation technology based on the images of the hip and ankle.\u00a0 The net effect is a component that is <\/span>specific for you<\/b>.\u00a0 It fits and it replicates your anatomy.\u00a0 The manufacturer is able to produce your knee in 5-6 weeks. In comparison, OTS knees which are manufactured in bulk and the surgeon selects the one that seems to fit the best from the choices available.\u00a0\u00a0<\/span><\/p> \u00a0<\/p> In the past several years I have enjoyed extensive experience with the ConforMIS knee having personally performed approximately<\/span> 4,000 cases.<\/b><\/p> The ConforMis knee has been demonstrated to produce improved outcomes compared to OTS knees in the following areas:<\/span><\/p> Computer Navigation Technology<\/b>:\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <\/b>I was one of the first surgeons in the US to routinely employ Computer Navigation in total knee replacement in the operating room.\u00a0 This enhanced my ability to properly align the total knee.\u00a0 The technology was expensive and added time to the operative procedure but was an important improvement.\u00a0 With ConforMis knees, the CT scan is employed to correct alignment using Navigation technology however; it is done in the manufacturing process by creating patient specific cutting jigs along with the patient specific components.\u00a0 This enables the advantages of Navigation however that portion of the procedure is done prior to going to the Operating room thus reducing cost and time in the OR.<\/span><\/p> Fixation of implant:\u00a0<\/b><\/p> Implants are fixed to the bone by using either <\/span>cemented <\/b>or <\/span>non-cemented <\/b>technique. Cemented technique is clearly the \u201c<\/span>gold standard<\/b>\u201d and according to most studies it produces the best long-term results. Sometimes non-cemented methods are appropriate. It requires \u2018in\u2019 growth of your bone into the implant to assure solid fixation. Although slightly less reliable than cemented technique, it can also produce good results.\u00a0<\/span><\/p> \u00a0<\/p> Pain Control Protocol, Medications, and Hospital Stay<\/b><\/p> \u00a0<\/p> Pain Control<\/b>:\u00a0<\/b><\/p> For several years I have been using what is referred to as a \u201c<\/span>multimodal\u201d <\/b>approach to pain management. It recognizes that there are various pain receptor sites in the brain and if we block those sites before we cause pain, the effect is much better than if we cause the pain and then try to \u2018catch up\u2019 with medication. Therefore, about an hour before the surgery we administer three different types of oral pain medications. We continue those for several days after the surgery to maintain the \u201cblockade\u201d of the receptor sites in the brain. Studies and experience has proven that this results in far superior pain relief.\u00a0<\/span><\/p> \u00a0<\/p> Pre-Operative Medications<\/b>:\u00a0<\/b><\/p> If there are medications that you have already been taking from home (home medications), we will discuss them at your pre operative appointment.\u00a0 There may be some that you need to stop taking before surgery.\u00a0<\/span><\/p> There are three basic types of receptor sites in the brain responsible for the transmission of pain. Each receptor type can be blocked with a specific medication. It is known that if we block the receptor site before the pain stimulus occurs, the result of reduced pain is far superior to that which occurs if the blockade is not started until after the pain stimulus happens. Again, approximately one hour prior to surgery, three separate oral medications are administered.\u00a0<\/span><\/p> All three of these medications are continued in relatively low doses throughout the hospital stay and for the first week or two after hospital discharge in order to keep the receptor sites constantly blocked.\u00a0<\/span><\/p> \u00a0<\/p> Anesthesia at time of Surgery<\/b>:\u00a0<\/b><\/p> I prefer, and almost require, regional anesthesia instead of general anesthesia, for total and partial knee replacement. Regional anesthesia means a spinal anesthetic combined with gentle sedation and a long acting local anesthetic injected in the tissues around the knee at the time of surgery.<\/span><\/p> This is superior in many ways\u2014<\/span><\/p> \u00a0<\/p>