TKR Surgery: The Day Before and Day of Surgery

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Preparation for surgery is very important. In prior articles I have talked about my preparation for surgery up to 6 months out.

In this article I want to focus on the specific preparation the day before surgery and the day of surgery. I had some specific instructions from both my surgeon and from my hospital team.

The day before surgery was a pretty normal day for me up until it was time for dinner. I was asked to avoid activities where I might fall, get cuts or scrapes and to avoid being around people with colds and infections.

I was told I could have a normal meal for dinner but that I should avoid alcohol. After midnight my instructions were to eat nothing and to drink no water. I was given a kit to bathe with the night before surgery and asked to use a clean towel and to have clean sheets on my bed.

I had a pretty normal night of sleep and then woke up and bathed with another kit from the hospital. I needed another clean towel and a clean change of clothing.

My Surprise The Day Before Knee Replacement Surgery

At 5:19 pm on the evening of my surgery I received a voicemail from my doctor’s office. The nurse informed me that my nose swab at the hospital a week ago came back positive for MRSA. My first thought was “oh boy” that after all these weeks preparing for surgery my surgery was now going to be postponed.

Thankfully, she went on to tell me that I only needed to get a particular nasal spray. I was to use the spray before going to bed and again when I woke up.

This was late in the day and I was getting ready for my last dinner and bath. My son headed to the pharmacy to get the over the counter nasal spray.

The pharmacist said he did not recognize the brand but after about a half hour he found a generic substitute. My son returned home at 7:15pm and we ate a much later dinner than planned.

After dinner I hurried to the bathroom with my bathing kit, clean nightclothes and a clean towel for my next step in preparation for surgery.

Bathing the Night Before TKR Surgery

During my pre-operation visit at the hospital they gave me a bathing kit to use the night before surgery and the morning of the surgery. In the kit were two separate packets, each had a washcloth and special soap (DYNA-HEX 2) (Chlorhexidine Gluconate 2% Solution) Antiseptic.

It also contained a waterproof instruction guide with a suction cup and ring so that I could hang the instructions inside the shower wall. I was also given a two minute sand timer to measure time.

The instructions told me to wash my genital area and above my neck with my normal soap and shampoo. Next I was to rinse off completely. Then, using the washcloth provided I was to use half of the container of soap to wash all body parts except my genital area and above my neck.

Again I was to rinse off completely. The final step was to use the remaining soap to re-wash my body, but this time I was to use the sand timer and leave the soap on for 2 minutes before rinsing.

After rinsing off, I used a clean towel to dry off. I put on clean bedclothes and went directly to my bed with clean sheets. I read for a short time and then set my alarm for 6:15 am and turned out the lights at 10:00 pm.

The Day of Knee Replacement Surgery

The alarm went off at 6:15. I got up after a good night’s sleep. I usually go right to the coffee pot but this morning no coffee, water, or food.

I gathered up my bathing kit and headed back to the bathroom. I used the second container of soap and repeated the process that I described last night.

I dried off with a clean towel and changed in to the clean clothes that I would be taking to the hospital. I also packed a second set of clothes and a warm sweatshirt just in case.

I figured my family could bring anything that I might need later. My wife and I backed the car out of the driveway at 7:30. I drove since I was told I would not be driving again for 6 weeks.

The hospital is about 11 miles away and we arrived in the parking lot at 7:50am.

Arriving to the Hospital For TKR

When I walked into the reception area the volunteer on duty greeted us, checked my name and told me she would let the receptionist know that I was there. I read the small local paper in the lobby and then the receptionist, Maureen, came out and greeted my wife and I.

She was familiar to me as she was the same person who registered me the week before. She told my wife that she could accompany me to the pre-op room.

She gave her a card with my patient number and explained to my wife that she could follow my progress on the patient monitors displayed throughout the hospital all day. She then walked us both down to the pre-op waiting room and turned us over to the staff there.

Total Knee Replacement Pre-op – Minutes Before Surgery

After a short wait I was greeted by Larry and Becky both RN’s. They told me that they would be preparing me for surgery.

Becky too was familiar as she did my pre op tests the week before. I was given an overview of what would happen in the next few hours as they prepared me for surgery.

I undressed and was helped into a hospital gown. She asked me a familiar round of questions concerning when I had last eaten and drank, what medications I had taken recently and which knee the surgery would be on.

After the questions the RN took my vitals. Next she shaved the area around my knee preparing it for surgery .The RN told me that she would be hooking me up with an IV port and that the Anesthesiologist would soon visit and explain my anesthesia options.

The doctor, who was doing surgery at the moment, would follow for a pre-op check. The doctor came in first and explained to both my wife and to me who the six person surgical team was to be and the probable timeline for recovery and admittance in to a hospital room.

He said he would call my wife shortly after the surgery and since we only lived 20 minutes away it might be best for her to return home and wait for the call. The last thing he did was to initial the correct leg for surgery.

Since I would be in the recovery room for 90 minutes or more we took his advice and my wife went home. Next the anesthesiologist came in and gave me my options for surgery.

I had two previous knee surgeries when I was in my twenties and had a good experience with a spinal block. I opted for the spinal block again. He told me he would sedate me some here in pre-op but that he would administer the spinal block in the operating room.

He also told me they would apply a tourniquet above the incision and that I would feel like I had a bruise there after surgery. Next he introduced me to two of the surgical nurses and the radiologist that would be on the team.

The surgery was on time and scheduled for 10:00 am. I was rolled into the surgery room and was moved from my pre-op bed to the operating room table.

I was beginning to feel a bit groggy but recognized and conversed with the surgical team. I was asked to sit up and lean over the bed so that the anesthesiologist could administer the anesthesia. I laid back down and the next thing I knew was that I was waking up in the recovery room.

Recovery Room After TKR Surgery 

I woke up in the recovery room at 12:45 pm and was greeted by a recovery room nurse. He gave me water to drink and encouraged me to drink often.

They began asking me what my pain level was on a 1 to 10 scale.  At this point I could only feel a slight tingling in my toes. The radiologist took some X-rays and I wandered in and out of sleep.

At 2:00 pm I was transferred into my hospital room. John was the 8:00 patient for my doctor and he was there already staking out the window bed.

I had the bed nearest the hall. I soon discovered that John had the desired bed. My hospital team introduced themselves and hooked up both legs to air cuffs that helped with blood circulation in and out of my legs. They also attached an ice cuff to my right knee and started circulating cold water around the swelling.

They gave me options for my pain medicine and it was decided that an oral dose of  ‘Percocet’ would be best for me. Every time they administered pain medication they asked me and wrote down my pain level on a 1-10 scale.

I was advised to drink as much water as possible. I had an IV putting fluid into my body and another drainage tube (for blood) exiting my knee near the incision.

The plan was to collect the drained blood and transfuse it back in to my body. They explained the advantage of having your own blood transfused as opposed to someone else’s blood.

I signed an okay for the procedure. Each patient had a white board with the team members’ names. It also listed my pain medications and when I had the last dose.

Finally it displayed instructions that I was able to get up and walk to the bathroom.

My son showed up very soon for a visit. He watched while I ate a container of red gelatin and we chatted for a while.

At 4:00 pm two physical therapists came into our room. They unhooked our 3 cuffs. They got my roommate John to stand up first with a walker and explained to us simple exercises we could do in bed.  The exercises included:

• Make circles with our ankles
• Move our ankles back and forth
• Press our legs and butt cheeks as hard as we can against the bed.

They had John stay in one place and march each leg up and down and they let him walk as far as his catheter would reach. Next, they got me to stand with a walker and do the same things that they had showed John.

Since I had asked not to have a catheter, I was able to walk with my IV to the bathroom and urinate for the first time. It was a short walk but pain free (due to the pain medicine) and I did not have any trouble urinating.

I returned to my bed and was hooked back up to all three cuffs (ice and 2 calf compressions). Even though my chart said it was okay for me to walk to the bathroom, I urinated in the bedside container throughout the night so that I did not have to unhook everything and carry my IV’s and drainage tube to the bathroom each time.

Once my drain tube bag was full, they hooked it up to the IV to put the blood back into my body. My wife showed up for a visit and relieved my son.

She sat with me, chatted and watched me eat a liquid dinner of low sodium chicken broth, orange gelatin, reduced calorie lemon sorbet, cranberry juice and decaf tea. Also on the tray was lemon juice and sugar.

After dinner they put more of the drainage blood back through the IV. I was introduced to the night team that was taking over at 6:00 pm. Shortly after 6:00 pm my wife went home and I settled in for my first night post surgery.

Check out Part 2 of My Time in the Hospital

Conclusion

In this article I have explained my preparation for surgery the day before and the day of the surgery. I also mentioned an unexpected surprise that I received the evening before surgery.

Unexpected things happen in life and I felt fortunate that the surgery went on as scheduled. I also explained in detail my bathing instructions the night before and the day of surgery.

It is important to be as germ free as possible. The day of the surgery went well for me. The staff was outstanding from the moment I entered the reception area.

I was very satisfied with the pre-op team, the surgical team and the team in the recovery room. I was surprised to find myself eating, urinating, visiting and up walking less than 4 hours after surgery.  The entire day went better than expected.

In my next article I will discuss my first night in the hospital and the second day up until my release at 12:30 pm. I hope you found this information and my other articles helpful as you prepare for your surgery.