The Joint Replacement Center at
Johnson City Medical Center
Knee Replacement - Hospital Care
What to Do
Arrive at Johnson City Medical Center, and proceed to 6th floor, 6500 wing (turn right as you come off the elevators and continue straight to the end of the hallway). Misty Spano, the Joint Program Coordinator, or a nurse will show you to your room.
What to Expect During the Surgical Experience
Upon arrival, you will be prepared for surgery in your room. A health history will be obtained and the nurse will cleanse the operative site. At the appropriate time you will be escorted to the surgery holding area where you will see the anesthesiologist. Following surgery you will be taken to a recovery area where you will remain for one to two hours. During this time, pain control will be established, your vital signs will be monitored and an X-ray will be taken of your new joint.
The surgeon will talk with your family or "coach" when your surgery is completed to let them know how the surgery went. You will return to your room where a total joint nurse will care for you. Most of the discomfort occurs the first 24 hours following surgery. During this time, you will be receiving pain medication through your IV (PCA). You will probably remain in bed the first day. It is very important that you begin ankle pumps on this first day. This will help prevent blood clots from forming in your legs. You should also begin using your Incentive Spirometer and doing the deep breathing exercises that you learned in class. Each day you will receive "KneeKnotes," a daily newsletter outlining the day’s activities.
Your physical therapist will set you up on your CPM (continuous passive motion) machine in the afternoon after your surgery is finished. Your operated leg will be placed in the CPM machine twice a day (5 a.m. and 5 p.m.) for two hours. Again, our goal is to get your knee bending to 90 degrees.
Day 1 - After Surgery
On day one after surgery you will be helped out of bed early by physical therapy and assisted to a chair. You will be seated in a recliner in your room. Your surgeon or physician’s assistant will visit you. The physical therapist will assess your progress and get you walking with a walker. IV pain medication will be stopped and you will begin oral medication. Remember to ask for your pain pills.
will begin in the afternoon. Your coach is encouraged to be present if possible. Our case manager will visit with you to discuss your needs for discharge from the hospital and begin making any necessary arrangements you will need.
Day 2 - After Surgery
On day two after surgery you will be helped out of bed early and will walk with a therapy assistant to group therapy. You will have group therapy in the afternoon. Your coach is welcome to participate in group therapy.
Day 3 - Discharge Day
Day three is similar to day two in the morning and you will walk on stairs. You will be discharged in the afternoon. This will occur after the afternoon therapy session. Discharge teaching will be done by nursing and physical therapy.
If You are Going Directly Home
Someone responsible needs to drive you. You will receive written discharge instructions concerning medications, physical therapy, activity, etc. Arrangements for equipment will have been done by Case Management.
If You are Going to a Sub-Acute Rehab (Skilled Nursing) Facility
The decision to go home or to sub-acute rehab will be made collectively by you, the case manager, your surgeon, your physical therapist and your insurance company. Every attempt will be made to have this decision finalized in advance but may be delayed until the day of discharge.
We will help you arrange for transportation. Transfer papers will be completed by nursing staff. Either your primary care physician or one of our hospitalists will be caring for you in consultation with your surgeon. Expect to stay for approximately one week, based upon your progress. Upon discharge home, instructions will be given to you by the sub-acute rehab staff.
Please remember that sub-acute stays must be approved by your insurance company. A patient’s stay in a sub-acute rehab facility must be done in accordance with guidelines established by Medicare/private insurance. Although you may desire to go to sub-acute when you are discharged, your progress will be monitored by your insurance company while you are in the hospital. Upon evaluation of your progress, you will either meet the criteria to benefit from sub-acute rehab or your insurance company may recommend that you return home with other care arrangements. Therefore, it is important for you to make alternative plans preoperatively for care at home.
In the event sub-acute rehab is not approved by your insurance company, you can always go to sub-acute rehab and pay privately.
Please keep in mind that the majority of our patients do well and don’t meet the guidelines to qualify for sub-acute rehab. Also keep in mind that insurance companies do not become involved in "social issues," such as lack of caregiver, animals, etc. These are issues you will have to address before admission.
Every Thursday on the Joint Replacement Unit we have a group lunch in the gym. We invite you and your family to come and enjoy socializing and eating with other patients who have had surgery during the week.
Please feel free to contact us if you have any questions (423)431-6937