Day of Surgery

Day 1 Post-Op

Nutrition and Elimination

• Intravenous (IV) started for fluids and medications
• Catheter inserted in bladder and urine output monitored for 24 hours
• Diet, as tolerated

• Fluids taken, as tolerated
• Sit up for meals, as able
• IV, as needed
• Catheter removed
• Start bowel routine
• Go to bathroom by commode chair/walker with assistance

Hygiene

• Assisted mouth and skin care, as required
• Dressing checked and reinforced, as needed

• Wash at sink or basin
• Dressing reinforced, as needed
• Hemovac removed at 24 hours

Wound Care

• Knee drained by hemovac, as required

• Wound monitored daily

Pain Control / Medications

• IV or oral medications for pain control once spinal wears off

• May have epidural

• Continue IV or oral pain medications
• Patient to ask for pain medications when needed

Activity / Rehabilitation

• Patient does the following post-operative exercises every hour when awake:
• Deep breathing and coughing
• Foot and ankle exercise
• Avoid resting knee in bent position on pillow
• Sit on side of bed and stand with assistance
• Walk, if able

• Deep breathing and coughing
• Transfer to and from bed and chair with assistance
• Sit up in chair for short periods
• Apply ice and elevate leg
• Ambulate using walker/crutches with assistance (not exceeding doctor-ordered weight limit on operated leg)
• Begin daily rehabilitation program to increase range of motion and exercises to strengthen operated leg

Discharge Planning

• Expected length of stay is 3-4 days
• Planned day of discharge written on bedside communication board

• Discharge needs are discussed with care providers (equipment, services)

Day 2 Post-Op

Day 3-4 Post-Op

Nutrition and Elimination

• Diet, as tolerated
• Sit up in chair for all meals
• Discontinue IV, as able

• Sit up in chair for all meals
• Enema or suppository given if no bowel movement

Hygiene

• Shower if able and if hemovac drain removed

Wound Care

• Remove dressing and redress if draining

• Expose incision when wound is dry

Pain Control / Medications

• Pain medication, as required, and coordinated with activity or rehabilitation schedule

• Pain control medication prior to exercise
• Review home instructions for self-administering Fragmin to help prevent blood clotting

Activity / Rehabilition

• Deep breathing and coughing
• Increase frequency of transfers to and from bed and chair, and increase independence of transfers
• Apply ice and elevate leg
• Increase distance and frequency of ambulation. Progress to crutches as able
• Continue exercises (with therapist and independently)
• Occupational therapy initiated as needed

• Deep breathing and coughing
• Progress to crutches, as appropriate
• Review procedure for climbing/descending stairs
• Review home exercises
• Apply ice and elevate leg
• Continue to increase independent transfers to and from bed and chair and ambulation to bathroom and hallway, as able
• Attend physiotherapy sessions
• Attend occupational therapy session to review tub transfers and dressing, if required

Discharge Planning

• Confirm discharge plan and equipment are in place
• Resources contacted, as required (ie. sub-acute facility, Home Care, mobile lab)

• Arrange out-patient physiotherapy if requested by surgeon (when new knee has less than 70 degrees of flexion and/or thigh muscles significantly weak)

Discharge Goals

Nutrition and Elimination

• Eating and bowel movements returning to normal

Hygiene

• Patient manages independently

Wound Care

• Surgical wound is clean and dry, or wound care management arranged for home
• Staple/suture removal arranged

Pain Control / Medications

• Pain management discussed with and understood by patient
• Required prescriptions provided to patient

Activity / Rehabilitation

• Patient is able to:
  • Achieve minimum 70 degree flexion in operated leg
  • Transfer to and from bed and chair, and stand independently and safely
  • Walk 30 metres using walking aid without exceeding doctor-ordered weight limit on operated leg
  • Climb and descend stairs safely
  • Perform home exercises and daily living activities safely (or has support in place at home for required activities)
• Patients requiring more rehabilitation will be transferred to a sub-acute facility

Discharge Planning

• Patient is given and understands:

  • Discharge instructions
  • Required exercise routine
  • Follow-up appointment dates