Patient Surgical Guides
Item #1
Nutrition Guide
Preoperative Nutrition Guide
Preparing your body nutritionally for knee replacement surgery is a vital step in ensuring a smooth recovery. Proper nutrition can enhance healing, boost your immune system, and improve your overall surgical outcomes. Here's how you can optimize your diet in the weeks leading up to your surgery:
Key Nutritional Components
- Protein: Essential for tissue repair and muscle strength. Include lean meats, fish, eggs, beans, and legumes in your diet.
- Complex Carbohydrates: Provide sustained energy and help maintain blood sugar levels. Opt for whole grains like brown rice, quinoa, and whole wheat pasta.
- Healthy Fats: Support cell function and reduce inflammation. Incorporate sources like avocados, nuts, seeds, and olive oil.
- Vitamins and Minerals: Crucial for immune function and wound healing. Focus on a variety of fruits and vegetables to ensure a broad spectrum of nutrients.
- Vitamin Supplementation: Consider supplements such as vitamins A, B (B12, B6, folic acid), C, D, and zinc to support post-operative healing.
Hydration
Stay Hydrated: Drink plenty of water throughout the day, especially the night before surgery. Proper hydration aids in circulation and helps prevent complications.
EnRoute: Your Convenient Nutritional Solution
If you prefer convenience and want to take the guesswork out of your preoperative nutrition, consider using EnRoute. EnRoute offers a comprehensive nutritional plan that includes everything you need in one place. It's designed to provide balanced meals with the right mix of proteins, carbohydrates, and essential nutrients to support your body before surgery.
Why Choose EnRoute?
- All-in-One Solution: EnRoute takes the hassle out of meal planning by providing pre-packaged, nutritionally balanced meals.
- Time-Saving: Perfect for those with busy schedules who want to ensure they're getting the right nutrition without the effort.
- Scientifically Formulated: Each meal is crafted to meet the dietary needs of preoperative patients, ensuring you receive optimal nutrition.
For more information and to explore EnRoute's offerings, click here.
By following these nutritional guidelines and considering EnRoute for added convenience, you'll be well-prepared for your surgery and set the stage for a successful recovery.
Item #3
Normal vs. Abnormal - When to Call Your Doctor
Signs of Infection
| What’s Normal? | What’s Concerning? |
|---|---|
| Slight warmth and redness near the incision from increased blood flow | Red, hot, and angry appearance like a sunburn |
| Small amount of clear fluid or blood drainage during the first week | Foul-smelling or unusual drainage from the incision |
| Mild temperatures up to 101°F (a normal inflammatory response) | Persistent fever above 101°F despite taking Tylenol, or systemic symptoms like chills or feeling unwell |
Excessive Pain or Swelling
| What’s Normal? | What’s Concerning? |
|---|---|
| Some swelling, especially at the end of the day, that improves with rest and elevation | Sudden, worsening pain or swelling that does not improve with rest, ice, and elevation |
| Bruising around the knee, thigh, or shin | Severe or hard swelling that may feel tight and painful, especially if accompanied by redness |
Changes in Your Leg
| What’s Normal? | What’s Concerning? |
|---|---|
| Temporary stiffness and mild difficulty with movement during recovery | New or worsening inability to move your toes or foot, or a sudden change in the appearance of your leg (e.g., pale or bluish skin) |
Difficulty Moving or Using Your Knee
| What’s Normal? | What’s Concerning? |
|---|---|
| Slight stiffness or difficulty with bending and straightening during the first weeks | Inability to bend or straighten your knee at all, or sudden locking of the joint |
Unusual Bleeding or Bruising
| What’s Normal? | What’s Concerning? |
|---|---|
| Bruising around the surgical site and leg that changes colors as it heals | Bleeding that soaks through dressings quickly or does not stop after applying pressure |
Changes in Mental or Physical Well-being
| What’s Normal? | What’s Concerning? |
|---|---|
| Mild fatigue or feeling tired as your body heals | Confusion, dizziness, or fainting, especially if it occurs suddenly or persists |
Incision / Wound Care
Wound/Incision Care Guide
Proper care of your surgical wound is essential for a smooth recovery and to prevent complications. Here's how you can take care of your incision and recognize signs of infection versus normal healing:
General Wound Care Instructions
- Incision Closure and Protection: In most cases, the incision will be closed with absorbable stitches underneath the skin and sealed with a purple skin glue. This glue is waterproof, allowing you to shower right away. Allow soapy water to run over the incision, but do not scrub. Pat the area dry gently with a clean towel.
- Avoid Submerging the Incision: Do not soak the wound in baths, hot tubs, Jacuzzis, or pools until cleared by your healthcare provider. This is typically allowed about six weeks post-surgery, once the scab has fully resolved.
- Dressing Changes: It is acceptable to leave the incision open to air. However, keeping a clean, dry dressing over the incision can enhance healing, especially when using collagen-containing dressings. Follow your healthcare provider's instructions on when and how to change your dressings, if applicable. Ensure your hands are clean before touching the wound or dressing.
- Protect the Incision: Wear loose-fitting clothing to avoid irritation. Avoid exposing the incision to direct sunlight, as this can cause permanent darkening of the scar.
Recognizing Infection vs. Normal Healing
Normal Healing:
- Swelling and Redness: Mild swelling and redness around the incision are common and part of the healing process.
- Bruising: Some bruising around the surgical site is normal and should gradually fade.
- Clear Drainage: A small amount of clear or slightly yellow drainage may be present initially.
Signs of Infection:
- Increased Redness and Swelling: Red, hot, and angry appearance like a sunburn, along with increased swelling.
- Warmth and Tenderness: The area feels warm to the touch and is tender or painful.
- Unusual Drainage: Foul-smelling, green, or pus-like drainage from the incision.
- Fever: A persistent fever above 101°F, despite taking fever-reducing medications.
- Systemic Symptoms: Chills, feeling unwell, or other systemic symptoms.
When to Contact Your Healthcare Provider
If you notice any signs of infection or have concerns about your wound, contact your healthcare provider immediately. Report any sudden changes in the appearance of the incision or your overall health.
By following these guidelines, you can help ensure proper healing of your surgical wound. Always consult with your healthcare provider for personalized advice and recommendations.
Understanding Your Medications
Post-Operative Medication Regimen
This comprehensive regimen is designed to:
- Prevent complications such as infections and blood clots.
- Support effective pain management while reducing dependency on opioids.
- Promote faster recovery by minimizing swelling and inflammation.
While the information below is generalized, note that your care team has tailored your specific plan to meet your individual needs, ensuring a safer and smoother recovery process. If you have any concerns or questions about your medications, don’t hesitate to ask.
1. Duricef (Cefadroxil) – Or other antibiotic
- Purpose: A 7-day course of cefadroxil has been shown to significantly reduce the risk of joint infections, especially for high-risk patients.
2. Blood Thinners – Aspirin or Xarelto
- Purpose: Prevents blood clots, a critical component of post-operative safety.
- Special Instructions: If you were taking a blood thinner prior to surgery, you’ll likely resume that medication after your procedure.
3. Docusate and Senna
- Purpose: Alleviates constipation caused by pain medications.
- Additional Tip: If constipation persists, you can add over-the-counter Miralax.
4. Tranexamic Acid (TXA)
- Purpose: Targets microscopic bleeding to reduce swelling and inflammation after surgery.
- Dosage: Taken twice daily for 14 days post-surgery.
5. Pain Medication Regimen
- See separate article: Understanding Your Pain Medications.
Understanding your Pain Medications
Pain Management Regimen
Pain management involves using multiple strategies together to maximize relief. Start with Level 0 and add levels as needed. Remember to add, not switch, as this regimen targets different parts of the pain pathway and works best as a combination rather than a single medication. Reduce medications as pain subsides, starting with the highest levels first.
Levels of Pain Management
Level 0: Rest, Ice, and Compression - Targets Swelling
- Often Underestimated! Don’t skip this step.
- Rest: Essential for recovery. Minimize activity to reduce inflammation and swelling.
- Ice: Use ice packs or a cooling machine to reduce pain and inflammation.
- Compression: Wear compression stockings or use an ACE wrap to manage swelling.
Level 1: Acetaminophen (Tylenol) - Targets Pain in the Central Nervous System
- Dosage: Take up to 1000 mg every 8 hours (maximum 3000 mg/day or 2000 mg/day if you have cirrhosis).
- Caution: Avoid combining Tylenol with alcohol.
Level 2: Anti-Inflammatory Medications - Targets Inflammation
- Options: (Pick one. Do NOT combine NSAIDs with steroids)
- Steroids (e.g., Prednisone): Use as prescribed.
- NSAIDs (Choose only one):
- Naproxen (Aleve): 500 mg every 12 hours (or 250 mg if over age 65).
- Ibuprofen: 400 mg every 6 hours (provides equal relief as 800 mg but with fewer side effects).
- Meloxicam: 15 mg daily maximum (7.5 mg if over age 65).
- Precautions:
- Avoid NSAIDs if you have kidney disease, are on blood thinners, are taking steroids, or have a history of ulcers.
- Diabetic patients: Monitor blood sugar closely while on steroids.
Level 3: CBD Products - Targets Endocannabinoid Receptors
- Recommended Product: Corganics Clinical CBD.
- Third-party tested for safety, potency, and purity.
- THC-free and high quality.
- Better absorption compared to over-the-counter options.
- Visit Corganics.com and use doctor authorization code "STEFANSKI".
Level 4: Lyrica (Pregabalin) or Gabapentin - Stabilizes Nerves to Reduce Pain Signals
- Usage: Take as prescribed. Provides maximum benefit in the first month after surgery.
Level 5: Spasm Medications - Relieves Muscle Spasms
- Options: Methocarbamol (Robaxin), Tizanidine (Zanaflex), etc.
- Recommendation: Methocarbamol is the least sedating and preferred.
- Usage: Used early when spasms are common; take only as needed.
Level 6: Opioids - Reserved for Severe Pain
- Examples: Oxycodone, Hydrocodone, Tramadol, Percocet, Vicodin.
- Caution:
- Use the smallest effective dose and taper off as soon as possible.
- Avoid prolonged use—dependence can develop after just 3 days.
- Be cautious with combination medications containing acetaminophen (e.g., Percocet, Vicodin) to avoid overdosing on the Tylenol component.
A Balanced Approach to Pain Management
By combining medications that target multiple aspects of pain, we can provide the greatest comfort and recovery experience. Remember, all pain fades with time. Stay strong—it’s temporary. If long-term pain management is needed, we’ll help you connect with a pain management specialist.
Post-Op Goals - Week by Week
Post-Operative Recovery Guide
Recovering from knee replacement surgery involves a series of steps and milestones to ensure a successful outcome. Here's a comprehensive guide to help you navigate the recovery process:
Week 1: Rest and Recover
- Goals:
- Minimize inflammation.
- Decrease swelling.
- Regain flexibility.
- Maintain good nutrition.
- Pain Management: Focus on using the prescribed combination of medications to reduce swelling and minimize pain.
- Mobility:
- Don't worry too much about building strength just yet. Focus on regaining your range of motion and allowing swelling to decrease. Avoid being overly active.
- Keep your step count below 750 per day to prevent inflammation. Being too active too soon can increase swelling, worsen stiffness, and potentially impact your long-term recovery.
- Use assistive devices like a walker or crutch for mobility and fall prevention.
- Swelling Management: Emphasize icing, elevation, and compression to help with swelling. Elevate your leg above heart level and apply ice packs regularly.
- Nutrition: Ensure a balanced diet rich in proteins, vitamins, and minerals to support healing and recovery. Consider using EnRoute for a convenient, all-in-one nutritional solution.
- Wound Care: Follow the wound/incision care guide to keep your incision clean and dry.
Weeks 2-4: Building Strength and Flexibility
- Physical Therapy:
- Many people who have minimally invasive knee replacement do not need formal physical therapy. Follow the activity guidelines on your MyMobility app and the therapy section of your joint replacement guide.
- We will evaluate at each follow-up visit if you’re on track with home exercises and whether or not formal therapy would provide a benefit.
- Increasing Activity:
- Gradually increase your walking distance and daily activities as tolerated.
- Try to maintain step counts within the recommended range.
- Focus on maintaining a balance between activity and rest.
- Monitoring Progress: If you had a smart knee replacement, it's now easier than ever to track your progress, including step counts. We can compare how you're doing to other patients in a similar demographic.
Months 2-3: Returning to Normal Activities
- Advanced Exercises:
- Continue with more advanced physical therapy exercises to regain full range of motion.
- Incorporate low-impact activities like swimming or cycling, if approved by your healthcare provider.
- Resuming Daily Activities:
- Begin returning to normal daily activities, such as driving or light household chores.
- Listen to your body and avoid overexertion.
- Follow-Up Appointments: Attend scheduled follow-up appointments to assess your recovery progress.
Long-Term Recovery: Months 4 and Beyond
- Maintaining Mobility:
- Continue with regular exercises to maintain strength and flexibility.
- Stay active with approved activities to support joint health.
- Lifestyle Adjustments: Consider lifestyle changes, such as weight management and a balanced diet, to support long-term joint health.
- Monitoring for Complications: Be aware of any signs of complications, such as persistent pain or swelling, and contact your healthcare provider if needed.
By following this recovery guide and working closely with your healthcare team, you can achieve a successful recovery and return to your daily activities with improved mobility and quality of life. Always consult with your healthcare provider for personalized advice and recommendations.
DVT Prevention
DVT Prevention Guide
Deep Vein Thrombosis (DVT) is a condition where blood clots form in the deep veins, usually in the legs. It's important to take preventive measures, especially after surgery, to reduce the risk of DVT. Here’s how you can protect yourself:
Recognizing a DVT
It's crucial to recognize the signs of a DVT early. Here's how to differentiate what's normal versus abnormal:
- Normal: Swelling and discomfort in the legs can be expected after surgery. Fluctuations are normal, especially as your activity levels increase. Normal swelling generally improves with elevating the leg to allow swelling fluid to return to the body, and with the use of compression stockings or an ACE wrap.
- Abnormal: Be alert for sudden changes, such as severe pain or diffuse, excessive swelling in one leg without an obvious cause like increased activity or a fall. This swelling typically involves the entire leg. Look for redness, warmth, and prominent veins extending from the affected area down the leg. If you experience these symptoms, contact your healthcare provider immediately.
Importance of Mobility
- Early Mobilization: Begin gentle movements and exercises as soon as possible after surgery to promote blood circulation. Follow your physical therapist's guidance on safe exercises to perform during your recovery.
- Regular Walking: Aim to walk short distances several times a day as you recover. This helps keep the blood flowing and reduces the risk of clot formation.
Compression Stockings
Use of Compression Stockings: Wear compression stockings as recommended by your healthcare provider. These stockings apply gentle pressure to your legs, helping to maintain blood flow and reduce swelling.
Medications
Anticoagulant Therapy: Your doctor may prescribe blood-thinning medications to prevent clot formation. It's crucial to take these medications exactly as directed.
Exercises for Reducing Risk
- Ankle Pumps: While sitting or lying down, flex your ankles up and down to encourage blood flow in your legs.
- Leg Lifts: Gently lift your legs while lying down to engage the muscles and promote circulation.
- Calf Raises: Stand and slowly raise your heels off the ground, then lower them back down. This exercise helps improve blood flow in the lower legs.
Lifestyle Adjustments
- Stay Hydrated: Drink plenty of water to keep your blood from becoming too thick and to support overall circulation.
- Avoid Prolonged Sitting: Try not to sit or lie down for extended periods. If you must sit for a long time, take breaks to stand up and move around.
By following these guidelines, you can significantly reduce your risk of developing DVT after surgery. Remember, while DVT is a serious condition, it is relatively uncommon. Most patients recover without complications. Always consult with your healthcare provider for personalized advice and recommendations.
Upgrade and Enhancer Your Recovery
Upgrades and Supplemental Options
Enhance your recovery journey with these recommended products and services designed to support your healing process and overall well-being:
Corganics
- CBD Products: Corganics offers a range of CBD products that may help manage pain and inflammation naturally. These products are formulated to support your recovery and promote relaxation. Visit Corganics.com and enter the code provided by Dr. Trevor
EnRoute
- Nutritional Solutions: EnRoute provides convenient, all-in-one nutritional plans tailored to meet the dietary needs of patients undergoing surgery. These plans ensure you receive balanced meals with essential nutrients to support healing.
Ice Therapy Machines
- Consistent Cooling: Ice therapy machines provide consistent cooling to the surgical area, helping to manage pain and reduce swelling more effectively than traditional ice packs. They are an excellent addition to your recovery toolkit.
- Insurance Coverage: Please note that ice therapy machines are not always covered by insurance, so be sure to inquire about this at your pre-op visit.
By incorporating these upgrades and supplemental options into your recovery plan, you can enhance your healing experience and achieve better outcomes. Always consult with your healthcare provider before introducing new products or services into your recovery regimen.