Created by Eidolon LLC

2018

Kee Replacement Pathway

Patient Selection

Generally, a patient that might reasonably benefit from a knee replacement has the following characteristics:

1. Less than 2 mm of joint space remaining on x-rays.

2. Symptoms requiring regular use of over-the-counter medications and significant

limitations in activities for greater than 1 year.

3. A three-month trial of a physical therapy supervised exercise program that might

either defer joint replacement or optimize fitness for joint replacement.

 

Operating Room Selection

Dr. Tower operates at Alaska Regional Hospital (ARH), Creekside Surgery Center (CSC),

and at Providence Alaska Medical Center (PAMC). All three have excellent operating

rooms and most often the choice of facility will depend on which one offers the lowest

out-of-pocket expense to the patient, usually dictated by the patient’s insurance

company and several other factors:

 

  • Creekside Surgery Center patients cannot be primarily covered by Medicare or Medicaid and need to be in good medical condition.

  • Dr. Tower's medical assistant will work directly with you to schedule surgery at the facility that most meets your needs for a specific date, while finding the facility that allows for the maximum reimbursement accordinging to your insurance requirements.

 

Patient Preparation

3 months before surgery:

 

  • Select operating room and date.

  • See physical therapist several times for conditioning program. Attend “joint camp” educational session.

  • See your dentist for a cleaning and to take care of any “unsound” teeth.

  • Arrange for 1-6 weeks of time off of work after surgery (duration of time off of work is dictated by your overall fitness and the type of work that you do).

  • See your primary medical provider so that your medical condition can be optimized.

  • Arrange for close support by a friend or family member for 1-4 weeks. The amount of time that you will need help depends on your fitness. You ought to plan that you will not be able to drive for 1-4 weeks after surgery. How soon you can safely return to driving depends on your fitness, whether you are still taking pain medications, and your vehicle. Determination of whether or not you are safe to return to driving is best made by a friend or family member, based on a proctored test drive in a deserted parking lot.

  • If you do not have a close friend or family member to assist you after surgery, the discharge planners at ARH or PAMC will help you arrange for home health care or a 1-6 week stay at an assisted living facility or a nursing home.

 

1 month before surgery:

 

  • See your primary medical provider to be cleared for surgery. At that appointment, the following tests need to be done and forwarded to Tower Orthopedic and Joint Replacement, in addition to the medical clearance:

    • EKG

    • CBC with differential, BMP, CRP, and ESR

    • UA with culture, if indicated

    • A nasal culture for staph (MRSA or MSSA).

  • Gather the following equipment (these can often be borrowed or obtained inexpensively second hand – check Access Alaska for a start):

    • Walker or crutches (your physical therapist can advise you on which one to get). You should use one or the other for 3-6 weeks after surgery, to be on the safe side, then you can progress to a stick in the hand opposite the replaced knee until you can walk without a limp.

    • An elevated toilet seat.

 

1 week before surgery:

  • Attend an appointment at TOJR for your pre-operative visit. The medications that you will be taking once you go home will be discussed and ordered at that time.

  • That same day you will go to the pre-admission testing office at the facility where your surgery is scheduled.

  • If additional lab work is required, it will be done at the facility’s pre-admission testing office.

 

Night before and morning of surgery:

  • Shower with chlorhexidine soap the evening before and the morning of surgery, using it on the knee that will be operated on.

  • ·Nothing to eat or drink for 8 hours before scheduled surgery time. You may take your morning medications with a sip of water.

  • If you take insulin in the morning, take one-half of your usual dose.

  • Do not take blood pressure medications in the morning that end with “pril” or “sartan” in the name.

  • Arrive at the pre-operative area 2 hours before scheduled surgery time.

 

1-3 days after surgery:

  • You will be on the orthopedic ward of ARH or PAMC, or you will be at Forestview Assisted Living Facility (2 floors above CSC).

  • Physical and Occupational therapy will work with you to ensure that you are safely mobile enough to go home.

 

First week after surgery:

  • Have a friend or family member change the dressing every other day.

  • You may shower with a waterproof dressing (Tegaderm) on.

  • Walk increasing distances with walker or crutches. You may put as much weight on the foot as you please.

 

7-14 days after surgery:

  • Brief follow-up appointment at Tower Orthopedic and Joint Replacement. Out of town patients may have this visit with their primary medical provider.

 

First 6 weeks after surgery:

  • Use a walker, crutches, or a cane in the opposite hand, even if you do not think you need it. It is better to be safe than sorry. Walk greater distances each day in a safe venue to maintain fitness. When you are not walking, lie down or sit in a recliner with your feet at heart level to control swelling of your feet.

  • Return to work (duration of time off of work is dictated by your overall fitness and the type of work that you do).

  • Return to driving. How soon you can safely return to driving depends on your fitness, whether you are still taking pain medications, and your vehicle. Determination of whether or not you are safe to return to driving is best made by a friend or family member based on a proctored test drive in a deserted parking lot.

  • Most patients do not need physical therapy during the first 6 weeks after surgery because they will already have been instructed on a home program that covers the first 6 weeks after surgery.

  •  

6-12 weeks after surgery

  • Follow-up appointment at Tower Orthopedic and Joint Replacement.

  • Arrive an hour early for x-rays downstairs at Diagnostic Health Anchorage first.

  • Determination as to whether physical therapy is desirable will be made at that time.

  • Determination as to when you might return to sport activities will be made at that time.

 

*  This is not medical advice.  Your treatment protocol will be determined by your provider in an individualized plan based on your surgical need and diagnosis.