In the Hospital

5. In The Operating Room
Following the pre-op holding area, you will be taken to the operating room. After induction of spinal and/or general anesthesia, the leg will be prepared with sterilizing solution and the surgical drapes applied. A pneumatic tourniquet will be applied to your upper thigh and inflated during surgery to decrease blood loss. A urinary catheter will be placed into the bladder. The surgery itself takes between two and four hours depending upon the complexity of the surgery. Counting the time for induction and emergence from anesthesia, this usually represents a total time of three to five hours.

6. Immediately after Surgery
After surgery, you will be taken to the recovery room where you will gradually become more and more awake. From the recovery room you will go to the orthopaedic floor. Occasionally, one or two days is required in the intensive care unit because of pre-existing medical problems such as heart or lung disease. When you are fully awake, you will be aware of the fact that you have a dressing on your entire leg from the toe up to the groin. Coming out of the dressing will be one or more drains which will be left in place for two to four days.

7. The Post Operative Hospital Stay
On the first or second postoperative day, your knee will be placed in a continuous passive motion (CPM) device which slowly moves the knee through a range of motion. The physiotherapist will help you out of bed and you will stand at the bedside for a few moments. If you feel up to it, several steps may be attempted only touching the toes down to the floor on the operative leg. The therapist will also instruct you on certain exercises to perform in bed.

The most important of which will be trying to achieve full extension of the knee. To prevent problems with the lungs postoperatively, you will be given an "incentive spirometer", an exercise machine for your lungs which you should use at least once on hour while you are awake in the first 24 to 36 hours after surgery. This helps you to reinflate your lungs and avoid pneumonia.

On the second or third postoperative day, you will begin walking, using a walker or crutches, putting only 10% of your weight on the operated leg, taking most of your weight on the walker or crutches and the opposite leg. Each day you will progress farther and you will begin to work on getting in and out of bed by yourself, sitting in a chair and arising, as well as using the bathroom or bedside commode.

8. Learning Activities of Daily Living
Initially, after surgery you will most likely have a catheter in your bladder so that urination will not be a problem. After this is removed, however, and for bowel movements, you will need to use either a bedpan or the bathroom with an elevated toilet seat. Occasionally, a bedside commode may be necessary. By the end of six or seven days, you will become independent getting in and out of bed, using the bathroom and performing routine activities of daily living. In addition to the physical therapist, an occupational therapist and the nursing staff will work with you on these functions. The key to going home is being functionally independent, having a dry, well healing wound with no temperature elevation and adequate pain control using oral medication.