3. Prehab

Total Knee Replacement and Hydration

Simple and important: Stay Hydrated!

Ideas for Prehab, Part II

7. Start drinking more water! It’s generally acknowledged that adults should drink between six and eight-8 ounce glasses of water a day. That hydration level is required for good health, maintaining adequate blood flow, and removing toxins from the body, which benefits the immune system. Water makes up about 60% of body weight and, among other factors, is critical for maintaining body temperature and lubricating joints.

Inadequate hydration reduces blood flow, diminishes the flow of white blood cells to the wound, and limits protection against infection. Reduced blood flow also lessens the amount of oxygen, vitamins, and nutrients that reach the wound and are required for healing. A decline of as little as 1 – 2% of the body’s fluid volume can trigger fatigue, and a drop of 10% can be fatal. Yet, the thirst mechanism that protects against dehydration weakens with age. By age 65, the same level of fluid volume decline that produces the mental thirst response (1-2%) can also trigger fatigue.

The conclusion seems obvious. Don’t wait until you are thirsty to drink

water to promote optimal healing. Keep a filled water bottle handy at all times and if you are bored with drinking plain water, try adding lemon, orange, or cucumber slices for a bit of flavor. If you are not in the habit of drinking that much water every day (and I certainly wasn’t!), add that to your prehab routine. Once you make it a habit, it’s one less thing to think about during rehab.

 
 
 

8. Learn controlled breathing as a natural tranquilizer:
Many times during your first few months post-surgery, you will want a way to soothe yourself without resorting to medication. You may be having a bad day. You may be in pain, depressed, or unable to sleep. If you are already practicing a controlled breathing technique, then, by all means, stay with what you know. The method I found most helpful was taught to me by my PT. I have since seen it online with various names, but they all have the same objective—to lower the pain level by taking deep, calming breaths that help the body relax.

1. Inhale slowly through the nose for a specific count;

2. Exhale through your mouth, lips pursed, for a specific count.

I use the following: Inhale for 6 counts, then Exhale for 8 counts.

3. Relax and allow your breath to naturally dissipate (without deliberately holding it.

4. Always keep the tip of your tongue touching the inner top of your mouth just above your upper front teeth.

Another popular controlled breathing method is the Square or Box breathing technique, which utilizes a four count for inhaling, holding then exhaling.

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Use less medication by learning controlled breathing to help reduce pain and to calm yourself

 

9.  Visit your dentist. Of all the things you need to get done before having TKR, seeing your dentist may not rank high on your list. It should. Dental procedures can result in bleeding gums which, in turn, can allow bacteria to enter your body via the bloodstream. Whereas the natural defense system of your body’s joints can fight off bacteria, your new prosthetic knee joint does not have such bacteria-resistant properties. While it is rare for a new prosthetic joint to become the site of a bacterial infection (a consequence in less than 1% of TKR surgeries), it is very serious when it does occur. Consequently, all dental work should be completed before surgery, from routine cleaning to more complex procedures. Since dental flossing can result in gum bleeding, purchasing an oral irrigator is also recommended, as is taking antibiotics before all dental visits in the future (if your doctor advises).

 
 

10. Assemble a recovery wardrobe. You may be surprised by how much comfortable clothes can make a recovery a bit easier.

• Pant legs should be loose to accommodate the swelling in your leg.
• Socks should be non-slip with grips on the bottom.
• Loose, warm tops or blankets wrapped around you add to the snuggle factor.

I was also surprised by how much my feet expanded after surgery. I could not wear any of my old shoes. Since I am not a shoe person, and after years of impairment, I had little but the absolute basics in footwear. I was happy to donate what I had to charity and began walking again in new, wider shoes.

I did learn something of importance that I want to share. If you have been using orthotics in your shoes, you need to remove them! After my first surgery, I couldn’t understand why walking was still so painful. Once I had removed the orthotics designed for my pre-surgical gait and purchased new wider shoes, my walking improved quickly. My newly realigned knees did not require those orthotics; they caused discomfort and got in the way of establishing a normal gait.

 

11. Get extra chair cushions/seat pads. These will make it easier to sit down and get up again and reduce the stiffness resulting from prolonged sitting periods. Once I realized this, I was never without my soft, padded cushion as I moved from room to room.

12. Gather your ice packs. Purchase or make yourself some ice packs to use during your recovery. Have a cooler or ice bucket nearby to keep them cold when you move them to your Recovery Nest for use during the day.

Also, this would be an excellent time to prepare and freeze meals for the future.