Total Knee Replacement, The Basics – What Happens Before Surgery?

When a patient has progressed to a point where arthritis of the knee causes daily pain, limitation of activity, and loss of motion, the patient, after a consultation with their orthopedic surgeon, may decide to have a total knee replacement. Once that decision is made, several things often take place. Often, the patient will be asked to either see or check in with their primary care provider to make sure that all of their medical issues are appropriately dealt with prior to surgery. The surgeon may ask the patient to donate a unit of their own blood. More recently, we have been moving away from this as we find that with various blood conservation techniques, we do not require a pre-donation of the patient’s blood and most often do not require any transfusions. There are preoperative education classes that are often required to further enhance the knowledge of the patient regarding the procedure and recovery process. The surgeon will review the x-rays prior to surgery, making a determination of which implant is appropriate and any special equipment that may be necessary for your surgery. 

On the day of admission, you will come to the hospital often two hours prior to the anticipated surgery time. You will check in and be evaluated by a preoperative nurse. Your medical history will be reviewed, an IV will be started, and prior to the procedure, antibiotics will be given to minimize the risk of infection. As part of a multi-modal pain management approach, you will be given some non-steroidal anti-inflammatory medication, Tylenol, and a long-acting narcotic before surgery to help minimize the pain that you have after surgery. Either prior or during surgery, you will be administered medication to minimize nausea and vomiting following the procedure. You will then be taken back to the operating room where preparation for your procedure will begin. From the time that you are taken back from the preoperative area to the operating room, it often takes approximately 30 minutes for the patient to be anesthetized (either a spinal or general anesthetic), have the leg prepped with special solution to clean the skin, and have appropriate draping carried out. After a confirmation of the patient, the side, and the procedure, surgery will begin.