My name is Dr. David Waddell. I am one of the founding members of Orthopedic Specialists of Louisiana. I practiced for over 40 years and retired in 2017. Years of sports, working on a farm and standing led to me having severe osteoarthritis. In 2018, the pain became so severe that I had my right Total Knee Replacement and the left one shortly thereafter. In my opinion, Specialists Hospital Shreveport is one of the best places in which to have your surgery done. With this as a background, I want to give you some hints that I feel will make your journey as a patient getting a TKR much easier.
- You’ve already decided to have the surgery, but don’t hesitate to ask you doctor ANY question that comes to your mind. Good communication with your Ortho team is vital to success.
- Get in the best physical condition that you can prior to your surgery. Lose those extra pounds. Do as much exercise as your body and knees will allow. Your doctor can provide you a complete list of great exercises to do.
- You need to be in the best mental condition as well. Patients with great attitudes just do better. Numerous studies have confirmed this fact. Talk with your primary care physician as well as your orthopedist about this fact.
- Your orthopedist may ask you to see a specialty physician prior to your surgery. This may be a cardiologist, pulmonologist or internist. This will be determined by your overall health condition. Don’t resist this workup, it’s for your own GOOD!
- Depending on the exact type of surgery that you will be having, you will need lab studies, EKG, chest x-ray, special knee x-rays or scans. Once again, this is to collect all the necessary information to insure the best outcome possible.
- If you are having a Makoplasty TKR (robot assisted), a CT scan will be needed to get the precise alignment data for the case. This is a painless x-ray study that only takes about 2-3 minutes to complete.
- JOINT CAMP is a preoperative class available at SHS in which you will be able learn about your knee surgery and surgical protocols specific to your surgeon. Be sure to attend this very important program. Again, ASK questions.
- An anesthesiologist (a doctor who will care for you while you have your surgery) will review your medical history and discuss the options available for anesthesia. You may need some specialized injections (blocks) to provide pain relief during and after your surgery. In the past, I had patients express concern over some of the injections. Now that I have had the surgery done, I would strongly URGE you to have the blocks. When I was fully awake following my surgery, I had NO pain due to the blocks. Not everyone has this exact experience, but the vast majority of the pain is relieved by them and all you may need post-op is a pill to augment the pain relief.
- Be sure to wash your leg before surgery with an antibacterial soap such as Dial soap. Your physician may make additional recommendations. Check with him or her.
- Your will be told to discontinue certain medications prior to surgery. If you take NSAIDs, such as Advil, Ibuprofen or Mobic, you will need to discontinue them at least a week before the surgery. Other meds also may need to be with held. Do not take Metformin, a diabetic agent, the day prior to your surgery. Heart and blood pressure medication guidelines vary. Discuss this with the anesthesiologist.
- It is probably wise to plan on having someone stay with you the night of your surgery. The nurses at SHS are great, but having someone there with you constantly will make you feel better.
- You should know that Medicare and many insurance companies now consider TKR a surgery in which the patient should be discharged on post-op day 1. Understand this going in, so you can make arrangements for your home care. If you live alone, be sure to let your doctor know so that arrangements can be made for you to go to a skilled nursing facility or someone to stay with you or you with them.
- Do you have steps to climb at home? Is your bedroom on the second floor of your home? Do you live in an apartment that has stairs and no elevator? Do you need a bedside commode? Do you need a walker and/or a cane? These are just a few of the important questions to consider.
- Discuss with your doctor what medications will be needed after your surgery. Pain meds and muscle relaxants may be needed. Your regular medications may need to be changed at least for a short period of time. This is especially true of blood pressure medications.
- Your will WALK within hours of your surgery. You will BEND your knee at that same time. Early ambulation and exercises have been show to improve outcomes. DO THEM!!!
- Don’t be afraid to move your leg as the physical therapist will direct you to do. Early motion means more motion later. Your incision is firmly repaired. Don’t worry. There may be some discomfort with the exercises. This is to be expected and does not mean that anything is wrong. Again DO the EXERCISES as frequently as you are told.
- When you get home, don’t be a couch potatoe!!! Get up. Walk with your walker. Have someone assist you if you feel weak. Again MOVE, MOVE, MOVE!!!!
- After leaving the hospital, if you go home, you will either have home PT or outpatient PT. This depends on your individual health, strength and social condition. If you live alone, you may need someone to stay with you or someplace to stay until you are more mobile.
- After discharge, call your doctor if you have ANY questions. There is a 24-hour answering service and one of the medical team will call you back. It’s a good idea to have a plan about where you will go if you have a medical emergency after surgery. SHS does not have an EMERGENCY ROOM. Discuss with your doctor where you should go if you need emergency evaluation or treatment.
- Prevention of blood clots in the legs or lungs is important. Elevation of your leg is important. Wear your special support hose as directed. Take either aspirin as directed or a prescription anticoagulant recommended by your doctor.
- Always go to therapy as directed. WORK hard at PT and at home. Half of a successful outcome for your TKR is up to YOU!!! Work!!!
- Make sure that you attend all of your post operative appointments.
- Finally remember, the only bad question is the one you don’t ask!
I hope these hints will help you have a great experience with your surgery and a wonderful outcome. The doctors, nurses and all the staff at SHS want only the best for you. They consider all SHS patients as family. They will do everything to make your surgery and hospital stay as comfortable and successful as it can be, as well as pray for your return to a healthy functional lifestyle.
David D. Waddell, MD
Fellow of the American Orthopedic Association.