Total and partial knee replacement

Understanding Knee Replacement

Using innovative joint replacement methods, Lee Health affiliated orthopedic surgeons reconstruct hundreds of knee joints each year. Treatments include routine and complex total knee replacement, revision of previously replaced joints that have worn out or failed, partial knee replacement, and arthroscopic knee surgery.

Overview

The Joint Center is the hub of our knee reconstruction and replacement program. Our Joint Center team strives to provide first-class care to all of our patients to help restore you to a higher quality of living. Every knee replacement patient who walks through our doors is treated with the personalized care that is the hallmark of our service. We also maintain a team atmosphere in our joint center, whether it is our highly skilled staff members working together to help you, or patients joining forces to help one another excel during the recovery process.

You will be involved in your comprehensive planned course of treatment every step of the way. This begins with a Pre-Op education class that helps you understand what to expect, and continues through your discharge from the hospital and recovery at home or in a skilled nursing/rehabilitation facility.

The Joint Center is the largest orthopedic program in southwest Florida and one of only a handful of wellness-based joint replacement centers in the country. The Joint Centers are located within three of Lee Health hospitals—Lee Memorial Hospital, Gulf Coast Medical Center and Cape Coral Hospital. They are one-of-a-kind in the region.

The Joint Center includes:

  • Pre-operative total joint education class
  • Navigators, nurses, therapists, care managers and patient care technicians who specialize in the case of knee replacement patients
  • Emphasis on group activities and individual care
  • Patient support person is educated to act as “coach” in the recovery process
  • A comprehensive patient guide for you to follow before your surgery and beyond
  • Reunion luncheons for former patients and coaches
  • Newsletters to update you with new information about arthritis and joint care
  • Public education seminars about hip and knee pain

Navigating Your Surgery

To contact an Orthopedic Nurse Navigator, call:

  • Cape Coral Hospital:
  • 239-343-0297
  • Gulf Coast Medical Center:
  • 239-343-0297
  • Lee Memorial Hospital:
  • 239-343-3341

What to Expect During Surgery


If you are scheduled for knee replacement surgery, here’s what to expect while you are in the hospital.

Surgery Day

The Pre-Op surgery nurse will greet and prepare you for surgery. This includes changing into a gown, reviewing medical information, starting an intravenous (IV) catheter in your arm to keep you hydrated with fluids and removing the hair from the operative area. The operating room nurse and anesthesiologist will review your medical history. Your anesthesiologist will explain the types of anesthesia you will receive and your pain management options.

Once your nurse has completed your preparation, a family member can sit with you until it is time for surgery.

After your surgery is finished, the surgeon will go to the waiting area to let your family know the procedure is completed. You will be transferred to the Post Anesthesia Care Unit (PACU) where you will wake-up after anesthesia. During this time, the PACU staff will work with you on managing your pain, monitor your vital signs, and take an X-ray of your new joint. Your stay in PACU is usually 1-3 hours.

You will then be taken to the orthopedic unit, where a nurse will care for you. Upon arrival to your room, you will be evaluated by a multi-disciplinary team to determine your plan of care. Your nurse will check your vital signs frequently. Only one or two family members or friends should visit you on this day.

It is very important that you begin ankle pumps on the first day. This will help prevent blood clots from forming in your legs. You should also begin coughing and deep breathing, along with using your incentive spirometer.

Day 1 - After Surgery

You will be given an opportunity to wash your face and hands and brush your teeth. Then, the staff will assist you with getting dressed.

Your surgeon and physician’s assistant will visit you during the day. IV pain medication will be stopped, and you will begin oral medication. Your nurse will begin teaching you about anticoagulation therapy, signs and symptoms of deep vein thrombosis, infection, medication management/side effects and incision care. You can expect a visit from your case manager to discuss any services, equipment and/or alternate placement required.

Group therapy will begin today and will be held twice a day. The physical therapist will assess your progress and help you walk with a walker. The therapists will make sure you can safely go up and down stairs.

Day 2 - After Surgery

Your day will start with a morning walk to exercise class. Most patients will be discharged after their first physical therapy session. Depending on your progress and special needs, you may be seen by an occupational therapist to go over any needs you have at home to help with daily functions such as dressing, bathing, hygiene and taking care of yourself at home.

Day 3 - After Surgery

This day applies to patients who are going to a skilled nursing facility or who were not discharged on Day 2. Day 3 is similar to Day 2.

After Surgery

Leaving the Hospital

When you are discharged from the hospital, you may go home with visits from a home health agency or you may go to a rehabilitation facility for additional therapy.

If you are going home with home health:

You will receive written discharge instructions concerning medications, physical therapy, activity, etc. Your physician will write orders for you to have home health. Our case managers will work with your insurance company to make these arrangements before you are discharged.

If you are going to a skilled nursing/rehabilitation facility:

The decision to go home or to a skilled nursing rehabilitation facility will be made collectively by you, the care manager, your surgeon, therapist and your insurance company. You will be asked for your preferences early in your hospital stay, so it is wise to visit 2-3 facilities prior to surgery. Also, check with the insurance company for preferred facility coverage.

Please remember that your insurance company must approve skilled nursing stays. A patient’s stay in a rehabilitation facility must be arranged in accordance with the guidelines established by Medicare.

Expect to stay seven to 21 days, based on your progress.

Please keep in mind that insurance companies do not become involved in “social issues,” such as lack of a caregiver, caring for pets, etc. These are issues that you will have to address before admission.


Caring For Yourself At Home

When you go home, there are a number of things you need to know for your safety, recovery and comfort.

Controlling Your Discomfort
  • Take your pain medicine with food at least 30 minutes before physical therapy.
  • Gradually wean yourself from prescription medication to Tylenol®. You may take two, extra-strength Tylenol in place of your prescription medication up to four times per day. Do not take extra Tylenol plus your pain medicines that contain Tylenol together or any additional over-the-counter products containing Tylenol.
  • Change your position every 45 minutes throughout the day.
  • Use ice for pain control. Applying ice to your affected joint will decrease discomfort, but do not use the ice for more than 20 minutes at a time each hour. You can use it before and after your exercise program.
Body Changes
  • Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Foods may taste different. Your desire for solid food will return.
  • You may have difficulty sleeping. Do not sleep or nap too much during the day.
  • Your energy level will be decreased for the first month.
  • Pain medication that contains narcotics promotes constipation. Increase your fluid and fiber intake. Eat a lot of fruits. Use stool softeners if necessary.
Stockings
  • You may be asked to wear special white stockings. These stockings are used to help compress the veins in your legs. This helps reduce swelling and the chance for blood clots.
  • If swelling in the leg that was operated on is bothersome, elevate the leg for short periods throughout the day. It is best to lie down and raise the leg above heart level using three pillows. Keep your leg straight.
  • Wear the stockings continuously, removing for one to two hours twice a day. Someone will need to assist you with putting on and taking off the stockings.
  • Notify your physician if you notice increased pain or swelling in either leg.
  • Ask your surgeon when you can discontinue stockings. Usually, you can stop wearing them three weeks after your surgery.
  • Make sure your stockings do not get bunched up on your legs, as this can affect circulation.
Caring for Your Incision
  • Keep your incision dry.
  • Your staples will be removed in 10 to 14 days.
  • Follow your doctor’s instructions on when to resume showering.
  • Notify your surgeon if there is increased drainage, redness, pain, odor or heat around the incision.
  • Please do not touch the incision unless absolutely necessary.
  • Take your temperature if you feel warm or sick. Call your surgeon if your temperature exceeds 101.5 degrees Fahrenheit.

Recognizing and Preventing Potential Complications

Infection

Signs of Infection
  • Increased swelling and redness at incision site
  • Change in color, amount and/or odor of drainage
  • Increased pain in knee
  • Fever greater than 101.5 degrees Fahrenheit
Prevention of Infection
  • Take proper care of your incision as explained.
  • Notify your physician and dentist that you have a total joint replacement.
  • Take prophylactic antibiotics exactly as prescribed by your provider when having dental work or other potentially contaminating procedures. Follow your doctor’s or dentist’s recommendations.

Blood Clots in Legs

Immobilization may cause the blood flow to slow and coagulate in the veins of your legs, creating a blood clot. This is why you must take blood thinners after surgery. Prompt treatment usually prevents the more serious complication of pulmonary embolus.

Signs of Blood Clots in Legs Might Include:
  • Sudden acute change in affected leg
  • Swelling from ankle up

Note: Blood clots can form in either leg. Total knee replacement patients may have many of these signs without having a blood clot in the legs.

Prevention of Blood Clots
  • Sequential Compression Devices (SCDs) such as foot and ankle pumps or Intermittent Pneumatic Compression Device (IPCD) placed around calf
  • Walking
  • Compression stockings
  • Blood thinners, such as Coumadin, Lovenox, aspirin, Xarelto and Arixtra. You will need to follow strict compliance while taking these blood thinners.

Pulmonary Embolus

An unrecognized blood clot could break away from the vein and travel to the lungs. This is an emergency and you should CALL 911 immediately if you suspect this has happened.

Signs of Pulmonary Embolus
  • Sudden chest pain
  • Difficult and/or rapid breathing
  • Shortness of breath
  • Sweating
  • Confusion
Prevention of Pulmonary Embolus
  • Prevent blood clot in the legs
  • Recognize a blood clot in the leg and call your physician promptly

Post-Op Exercises and Goals

Activity Guidelines

Exercising is important to obtain the best results from knee surgery. You may receive exercises from a physical therapist at an outpatient facility or at home. In any case, you need to participate in an ongoing home exercise program, too.

Weeks 1 and 2

After 2-3 days, you should be ready to be discharged from the hospital. Most joint patients go directly home, but you may go to a skilled nursing facility for seven to 21 days. During the first and second weeks of your recovery, your two week goals are the following:

  • Continue with a walker or cane unless otherwise instructed.
  • Walk at least 300 to 500 feet with your assistive device.
  • Climb and descend a flight of stairs (12 to14 steps) once a day using a railing.
  • Actively bend your knee up to 90 degrees.
  • Straighten your knee completely.
  • Independently sponge bathe or shower and dress.
  • Gradually resume household tasks.
  • Do 20 minutes of home exercises four times a day, with or without the therapist, from the program given to you.
Weeks 2-4

During weeks two through four, you will gain more independence. Even if you are receiving outpatient therapy, you will need to be very faithful to your home exercise program to achieve the best outcome. Your goals for the period are the following:

  • Achieve one- and two-week goals.
  • Wean from full support to a cane or single crutch as instructed.
  • Walk at least a quarter mile.
  • Climb and descend a flight of stairs (12 to14 steps) more than once daily.
  • Bend your knee more than 100 degrees.
  • Independently shower and dress.
  • Resume household tasks.
  • Do 20 minutes of home exercises, twice a day, with or without your therapist.
Weeks 4-6

During weeks 4-6, you will get closer to full independence. Your home exercise program will be even more important as you receive less supervised therapy.

Your goals for this time period are the following:

  • Achieve one- to four-week goals.
  • Walk with a cane.
  • Walk a quarter to a half mile.
  • Begin progressing on stairs from one foot at a time to regular stair climbing (few stairs at a time).
  • Actively bend knee 110 degrees.
  • Drive a car, with surgeon’s approval.
  • Continue with home exercise program twice a day.
Weeks 6-12

During weeks 6-12, you should be able to begin resuming all of your activities.

Your goals for this time period are the following:

  • Achieve prior goals.
  • Walk with no cane and without a limp.
  • Climb and descend stairs in a normal fashion (foot over foot).
  • Walk one-half to one mile.
  • Bend knee to 120 degrees or more.
  • Straighten knee completely.
  • Improve strength to 80 percent.
  • Resume all activities, including dancing, bowling and golfing

Do’s And Don’ts for Long Term Joint Health

All joint patients need a regular exercise program to maintain their fitness and the health of the muscles around their joints. With your orthopedic and primary care physicians’ permission, you should be on a regular exercise program three to four times per week, lasting 20-30 minutes. Impact activities, such as running and singles tennis, may put too much load on the joint and are not recommended. High-risk activities, such as downhill skiing, are discouraged because of the risk of fractures around the prosthesis and damage to the prosthesis itself. Infections are always a potential problem.

What to Do in General
  • Take antibiotics as prescribed by your dentist or physician. Some patients may need to do this long term. Ask your physician.
  • Although the risks are very low for post-operative infections, it is important to realize that the risk remains. A prosthetic joint could possibly attract the bacteria from an infection located in another part of your body.

If you should develop a fever of more than 101.5 degrees Fahrenheit, or sustain an injury such as a deep cut or puncture wound, you should clean it the best you can, put a sterile dressing or Band-Aid on it and notify your doctor. The closer the injury is to your prosthesis, the greater the concern.

Occasionally, antibiotics may be needed. Superficial scratches may be treated with topical antibiotic ointment. Notify your doctor if the area is painful or becomes red.

  • When traveling, stop and change positions hourly to prevent your joint from tightening.
  • Visit your surgeon yearly unless otherwise recommended.
What to Do for Exercise
  • Recommended exercise classes
  • Home program as recommended by therapist
  • Regular one- to three-mile walks
  • Home treadmill (for walking)
  • Stationary bike
  • Regular exercise at a fitness center
  • Low-impact sports and activities, such as golfing, bowling, walking, gardening, dancing, etc.
What Not To Do
  • DO NOT run or engage in high-impact activities
  • DO NOT participate in high-risk activities, such as downhill skiing, etc.

The Importance of Follow-Up Visits

During the past several years, orthopedic surgeons have discovered that many people do not follow up with their surgeons on a regular basis. They may not realize they are supposed to or they may not understand why it is important.

So, when should you follow up with your surgeon? These are some general rules:
  • Every year, unless instructed differently by your physician
  • Anytime you have mild pain for more than a week
  • Anytime you have moderate or severe pain

Why? Two things could happen. Your knee could become loose and lead to pain, or the cracked cement could cause a reaction in the bone called “osteolysis,” which may cause the bone to thin out and lead to loosening. In both cases you might not know this for years. Orthopedists are constantly learning more about how to deal with both of these problems. The sooner we know about potential problems, the better chance we have of avoiding more serious problems.

  • The second reason for follow-up is that the plastic liner in your knee may wear. Little wear particles combine with white blood cells and may get in the bone and cause osteolysis, similar to what can happen with cement. Replacing a worn liner early and grafting the bone can keep this from worsening.

X-rays taken at your follow up visits can detect these problems. Your new X-rays can be compared with previous films to make these determinations. This should be done in your doctor’s office. Fortunately, most patients do so well that they do not think of us often.

  • Anytime you have signs and symptoms of an infection

There are two good reasons for routine follow-up visits with your orthopedic surgeon:

  • If you have a cemented knee, we need to evaluate the integrity of the cement. With time and stress, cement may crack. You would probably be unaware of this because it usually occurs slowly, over time. Seeing a crack in cement does not necessarily mean you need another surgery, but it does mean we need to follow things more closely.

Contact

Information Resources

  • Orthopedic Nurse Navigator Program:
  • 239-343-3341
Joint Center at:
  • Cape Coral Hospital:
  • 239-424-3150
  • Gulf Coast Medical Center:
  • 239-343-0300
  • Lee Memorial Hospital:
  • 239-343-3411

Follow-Up Care and Programs for Rehabilitation and Wellness

  • Home Health Services:
  • 239-225-7700

There’s no place like home when you are recovering from surgery, ill or disabled and need extra help. Today, high technology medical equipment for use in the home provides treatments and services that once were available only in the hospital. In the privacy of your own home, you can receive highly skilled care from Lee Health – Home Health Services’ registered nurses; physical, speech and occupational therapists; certified home health aides and medical social workers. Our case managers will make these arrangements for you prior to your discharge.

  • HealthPark Care Center:
  • 239-343-7300

At HealthPark Care Center, our goal is to help people help themselves. We offer all the services of a skilled nursing facility, including a full range of rehabilitative and subacute services. HealthPark Care Center combines the most current and comprehensive geriatric treatment with the care and compassion needed for residents to reach their maximum potential. Our case managers will make these arrangements for you prior to your discharge.

  • Skilled Nursing Unit at Lee Memorial Hospital:
  • 239-343-3390

The Lee Memorial Hospital – Skilled Nursing Unit is an 18 bed unit located on the 3rd floor of our downtown hospital. The unique setting allows for seamless patient transitions while also providing the amenities, services and comfort of the hospital. Our goal is to assist each patient with their rehabilitation needs and prepare them to return back to the community as quickly as possible.


Outpatient Rehabilitation Services

Lee Health provides high quality, comprehensive rehabilitation services including physical therapy, occupational therapy and speech therapy for all ages. A referral from your physician is required to schedule an appointment with a therapist. Once you have received the referral, please contact us at 239-424-1499 to set up an initial appointment.

  • Outpatient Rehabilitation at City Center
  • 3114 Cleveland Ave.
  • Fort Myers, FL 33901
  • 239-343-4980
  • Riverwalk Sports Medicine & Rehabilitation
  • 8350 Riverwalk Park Blvd.
  • Suite 2
  • Fort Myers, FL 33919
  • 239-343-8850
  • Outpatient Center at HealthPark Commons
  • 16281 Bass Rd.
  • Suite 200
  • Fort Myers, FL 33908
  • 239-343-7244
  • Outpatient Rehabilitation at Gulf Coast Medical Center
  • 13685 Doctors Way
  • Suite 250
  • Fort Myers, FL 33912
  • 239-343-1645
  • Outpatient Center at the Sanctuary
  • 8960 Colonial Center Drive
  • Fort Myers, FL 33905
  • 239-343-9460
  • Outpatient Rehabilitation at Cape Coral Hospital
  • Cape Coral Hospital
  • 636 Del Prado Blvd.
  • Cape Coral, FL 33990
  • 239-424-2317
  • Outpatient Rehabilitation at Bonita Bay
  • 26800 S. Tamiami Trail, Suite 3, Bonita Springs, FL 34314
  • 239-495-4495

Wellness Centers

Lee Health’s Wellness Centers are a member of the Medical Fitness Association and backed by the medical experts of Lee Health. Our fitness specialists will design an individualized fitness program to meet your fitness goals, and are available to track your progress and make adjustments, as needed. Group exercise classes, aerobic and weight training, personal coaching, aquatics are some of the many programs available. Discounts are available for Joint Center graduates.

  • Wellness Center of Fort Myers
  • 3114 Cleveland Ave.
  • Fort Myers, FL 33901
  • 239-343-4980
  • Wellness Center of Cape Coral
  • 609 SE 13th Ct.
  • Cape Coral, FL 33990
  • 239-424-3220

Frequently Asked Questions (FAQs)

Below are some of the most commonly asked questions about knee replacement surgery .


Q What is arthritis and why does it hurt my knee?

A The leading cause of joint pain, Osteoarthritis, is also known as degenerative joint disease. The cartilage that serves as a cushion and allows for smooth motion of the knee breaks down and wears away. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.


Q What is a total knee replacement?

A A knee replacement is a surgical procedure in which the surgeon removes the damaged bone and cartilage at the ends of the bones in your joint and replaces it with artificial parts. The goal of knee replacement is to allow you to move easily with less discomfort.


Q What is partial or uni-compartment knee replacement?

A A partial or uni-compartmental knee replacement is a procedure in which only one of the three compartments in the knee is repaired. Candidates for this procedure have arthritis primarily in the medial compartment of the knee. Your surgeon will determine if this is the right procedure for you.

Q Will I need blood?

AThe majority of knee replacement patients do not require a transfusion after surgery.

Q Do I need to be put to sleep for this surgery?

A You may have a general anesthetic, which most people call "being put to sleep." Some patients prefer to have spinal or epidural anesthetic that numbs your leg only and light sedation. The choice is between you and the anesthesiologist.

Q How long until I can drive and get back to normal?

A The ability to drive depends on whether surgery was on your right leg or your left leg, and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks if you are not taking narcotics. If the surgery was on your right leg, your driving could be restricted for as short as two weeks or as long as six weeks. Getting "back to normal" will depend on your progress. Consult with your surgeon or therapist for their advice on your activity.


Q When will I be able to get back to work?

A We recommend that most people take at least one month off from work, unless their jobs are quite sedentary.


Q How often will I need to be seen by my doctor following the surgery?

A You will be seen for your first post-operative office visit two weeks after surgery. The frequency of follow-up visits will depend on your progress.


Q Do you recommend any restrictions following this surgery?

A Yes. High-impact activities, such as running, downhill skiing, singles tennis and basketball are not recommended.


Q Will I notice anything different about my knee?

A Yes. You may have a small area of numbness to the outside of the scar that may last a year or more and is not serious. Kneeling may be uncomfortable for a year or more, but you can kneel if you want to. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious. You may notice that your knee is warm for up to one year, again, this is not unusual. It is your knee healing from the surgery.

Need an Orthopedic Specialist?

Call our physician referral specialists for assistance:

239-495-4475

Request a Call Back

Do you have questions about your health or wellness? Request a callback to speak with a physician referral specialist who can help you find a Lee Health doctor or guide you to a service.