Knee Replacement Guidebook
Getting Ready for Surgery
Knee Replacement Guidebook Home | Getting Ready for Surgery | What to Expect the Day of Surgery | Physical & Occupational Therapy | At Home After Surgery
You probably have many questions about how to prepare yourself and your home for surgery.
The checklists in this section are designed to help guide you through this preparation process.
For general information, see the Common Knee Conditions & Treatments section (www.dhmc.org/ortho/knee).
- Prepare Your Body
- Health Questionnaire & Patient Online
- Our Billing Policy
- Additional Support After Your Surgery
- Your Pre-Surgery Appointment
- What Should I Pack for the Hospital?
- Checklist for the Day/Night Before Surgery
- Changes Inside My Home
- Selecting a Rehabilitation or Skilled Nursing Facility
This tip list can help your body get a healthy start before you head into the operating room:
- Eat healthy foods like fruits, vegetables, lean meats, and whole grains
- Get plenty of rest
- Reduce or quit smoking
- Reduce or stop drinking alcohol
- Start practicing your fifteen essential exercises to start preparing your muscles (see Physical & Occupational Therapy)
- Exercise as much as your body can tolerate to improve and/or maintain your muscle stregth
- Check to see if friends or family members have a two-wheeled walker, a raised toilet seat (or three-in-one commode), and a tub bench to put in your shower; if they do have these items, you can practice using the walker before surgery and have the bathroom items at your home, ready for use after surgery; if family or friends do not have these items, we can help you get the equipment you will need after surgery - please do not buy these items before your surgery
We highly suggest that you get your flu shot and, if you are eligible, a pneumonia shot (pneumococcal); you should get these shots preferably two weeks before your surgery; your family and caregivers should also be vaccinated.
IMPORTANT NOTE: If you happen to become ill within the weeks or days before your surgery, even if it is a simple cold, please contact us right away. We may need to reschedule your surgery until you are health again.
Health Questionnaire & Patient Online
At various appointments, you will be asked to take a health questionnaire so that we can track your progress and keep your health records up to date. You will complete this set of questions using an electronic tablet which our reception staff will show you how to use.
If you like, you can complete this questionnaire online before your appointment. To do this, you will need to register for Patient Online, a free online resource we offer our patients. Patient Online allows you to email questions to your healthcare providers, request or reschedule appointments, and much more. To register, visit www.dartmouth-hitchcock.org/patientonline.
You will need to register at least two weeks before your pre-surgery appointment to allow enough time to get your password set up. If you do not have access to a computer with internet access, feel free to use one of the many computer terminals in the Health Education Center on Level 4 at DHMC. Staff members are available to assist you.
If you have questions about billing, insurance, financial assistance or charges for healthcare services, please contact Patient Financial Services at (800) 368-4783 or (603) 653-1047.
The staff in Patient Financial Services are also happy to help those patients who do not have insurance coverage.
Additional Support After Your Surgery
Before surgery, you will be asked the following questions to help us determine if you need will special assistance following your surgery:
- Do you live alone?
- Do you need help with daily living?
- Do you have any concerns about going home after surgery?
- Would you like to learn about facilities that provide care and rehabilitation before you go home? See the end of this section for more information on this topic.
If you answered “yes” to any of the questions, you may be referred to the Office of Care Management.
The Office of Care Management can help you:
- Figure out your finances and insurance coverage (including Medicare and Medicaid)
- Consider alternatives to going directly home (nursing facilities, rehabilitation centers)
- Cope with emotional stress
- Find lodging (or transportation) for family
- Arrange discharge plans that fit your needs and your family's immediate and future needs
Please refer to the Office of Care Management website that describes the services offered by the Office of Care Management and the options available to you after you are discharged from the hospital.
Feel free to call the Office of Care Management at (603) 650-5789 for assistance any time.
About 30 days before the date of your surgery, you will have an appointment in Pre-Admission Testing. This department helps patients to complete the necessary medical testing and paperwork for hospital registration.
During the appointment, you will answer an anesthesia health quiz that takes approximately 20-30 minutes to complete using an electronic tablet. This is a different survey from the health questionnaire that you will take at various appointments, as mentioned in the Health Questionnaire & Patient Online section. Your answers will provide your anesthesiologist with your specific health information that he or she will use to recommend the anesthesia for your surgery.
After completing your quiz, a nurse will meet with you to discuss any special needs you have. Depending on your medical history, you may have blood work drawn, a heart tracing (EKG), and/or a chest x-ray. Your surgeon will decide which tests are necessary.
Our current auto-transfusion program allows us to give you back your own blood, so pre-operative blood donation is unnecessary most of the time. If you physician decides that you do need to donate blood prior to surgery, our scheduling team will make the arrangements with you ahead of time.
What Should I Pack for the Hospital?
Our suggestions include:
- Flat, supportive, athletic or walking shoes so that you won't slip
- Short night gown, loose pajamas, or baggy shorts to fit over dressings
- Short, light-weight bathrobe
- Toiletries such as a toothbrush, toothpaste and deodorant; the hospital has complimentary toiletries if you happen to forget something at home
- Eyeglasses instead of contacts -glasses are easier to take care of and are less likely to be lost
- Dentures - we can give you a storage container if you need one
- A list of medications that you take, dosage and frequency, including any that you stopped taking for the surgery
- Telephone numbers of people that you may want to call
- A small amount of money for newspapers, gift shop items, etc.
- A book, magazine, or other portable hobby
- A “going home” outfit like a sweat suit or other clothing that is easy to put on and take off
- This guidebook to use as a reference and to make note of special instructions or questions you may have during your stay
SPECIAL NOTE ABOUT SHAVING:
Please do not shave your surgical area prior to your surgery. Your surgeon will inspect your knee(s) the morning of your surgery and will carefully shave the area at that time. If there are breaks in your skin, your surgery may need to be rescheduled because you may be at risk of developing an infection.
Checklist for the Day/Night Before Surgery
- Enjoy a regular dinner
- A nurse from the Same Day Program will call you on the day before surgery (or on Friday if your operation is on Monday) and will leave a message if you are not home regarding:
- When to stop having anything to eat or drink (usually midnight)
- Which medications to take the morning before surgery
- What time you should plan to arrive at the hospital
- You may brush your teeth and rinse out your mouth the morning before surgery
- You will be given anti-bacterial soap packets called Hibiclens; you will need to wash with this special soap the night before your surgery and the morning of your surgery to help decrease the chance of infection; see the washing instructions; if you did not receive the soap packet or misplaced it, you can use another anti-bacterial soap, such as Dial®
- When you shower the night before and the day of your surgery, use a brush to scrub your nails
- After your shower the night before surgery, put clean sheets on your bed and wear a clean set of pajamas
Since you will have limited mobility after surgery, there are many modifications that can be done in your home ahead of time to make life easier. Many of these things should be considered well in advance of your surgery date so plan accordingly.
Prepare Your Home
- Buy a cordless telephone
- Gather a supply of empty plastic or canvas bags to hang on the front of your walker to help carry things
- Wearing an apron with pockets can also help you carry items
- Place frequently used kitchen items like glasses or a teapot in easily accessible places, such as a countertop or on the lowest shelf in an overhead cabinet
- Buy or make individual meals that can be frozen and reheated easily
- Alert family and friends who can help you with your everyday needs
- Be sure that there is a clear path to the entrance of your home:
- Shovel snow from sidewalk/stairs
- Rake leaves
- Clean out the garage
- Clear clutter from the floors of your home and remove small area rugs so you won't trip and fall
- Make arrangements for a friend or kennel to care for your pets the first few weeks after you return home; they could cause you to fall and injure you new knee(s)
Prepare Your Shower
- A tub bench or seat is recommended. If your shower is also a bathtub, you will need a seat without arms. If you shower in a stall, you can use any seat you like. The most important thing to remember is that your seat needs to be non-skid. This means that chair or stool should have rubber tips on the bottom of the legs, or you should pu ta non-skid shower mat under the chair or stool.
- Some patients find that a hand-held shower hose helps. Installing one is fairly easy and does not require a plumber.
- Place your soap, shampoo and other shower items in a spot that does not force you to bend or twist to reach them.
Adjust Your Toilet
- If you are taller than 5′2″, you may need to raise the of height your toilet, unless it is already handicapped accessible.
- If your toilet is not handicapped accessible, we recommend that you use a raised toilet seat with or without arms or a three-in-one commode.
- If you have friends or family or who already own the above items, please ask to borrow them and install them in your home before surgery. If not, our joint team can order the equipment you need after your surgery and have it delivered to your home.
Selecting a Rehabilitation or Skilled Nursing Facility
Most patients are able to go home directly after their surgery to begin their recovery. However, there may be occasions when your physician recommends that you go to a rehabilitation or skilled nursing facility for an extra level of care and attention. If this is the case, our Care Management team will attempt to make arrangements with the facility of your choice during your hospital stay.
Every effort will be made to get you into the facility of your choice, however, options and bed availability may be limited. Please understand that Medicare requires that patients take the first available bed in a rehabilitation or skilled nursing facility that meets their needs. Medicare may deny payment of your stay at the hospital if you don't take the first available spot.
Transportation to the facility will be decided by your healthcare team. Many patients are able to travel with a family member in their car. Others may need a wheelchair van or ambulance transportation. Medicare will cover non-emergency ambulance transportation if you are confined to your bed and have a note from your doctor. Even if you are not confied to your bed, they may still cover your ambluance trip if you have a note from your doctor. If the ambluance company believes Medicare will not pay for your transportation, they may ask you to choose an option and sign and Advance Beneficiary Notice which will hold you responsible for payment if Medicare does not pay the cost of your transportation. Medicare does not pay for wheelchair vans. Rest assured that your doctor and the Office of Care Management will assist you with transportation options when the time comes and will make you aware of the options available to you.
Please refer to the Rehabilitation or Skilled Nursing Facility Reference Map (below) that shows rehabilitation and skilled nursing facilities in our region.
To understand what each type of facility offers, please see the blue booklet entitled “A Guide to Understanding your Discharge Options After Hospitalization.” We urge you to arrange a visit with those you are interested in prior to your surgery. Our staff has toured most of these facilities and we feel confident that they provide excellent care for our patients.
Once you've had a chance to review and/or visit your top choices, please note them on the card below. We will ask you to return this completed form at the Total Joint Class or the pre-operative Shared Medical Appointment (SMA) you'll be attending prior to your surgery.
If you have questions about selecting a facility, please contact the Office of Care Management at (603) 650-5789.
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Knee Replacement Guidebook Home | Getting Ready for Surgery | What to Expect the Day of Surgery | Physical & Occupational Therapy | At Home After Surgery
