Total Knee Arthroplasty ERAS

In a total knee arthroplasty (also called knee replacement surgery), damaged parts of the knee joint are removed and replaced with artificial implants. It's most commonly a treatment for osteoarthritis, a condition characterized by the breakdown of joint cartilage.

Our total knee arthroplasty ERAS program is designed to help patients return to health more quickly after undergoing the procedure.

Before Surgery

• Your surgeon will meet with you to explain surgical plans and set expectations for your surgery.
  • If questions arise, contact your surgeon via MyChart or call the Orthopaedic Clinic: 214-645-3300.
• You will receive instructions for surgery and medications via a phone call prior to surgery. You might also be scheduled for an appointment in our Pre-Surgical Testing Clinic to meet with our anesthesia team or have bloodwork drawn.
  • We may request testing or records from your other physicians.
  • Call our Pre-Surgical Testing Clinic with any questions: 214-633-4202.
• Lifestyle modifications:
  • You must stop smoking for one month prior to surgery, and we encourage you to stop consuming alcohol for one month prior to surgery.
  • We encourage you to increase your physical activity prior to surgery as tolerated. You will receive specific instructions during your pre-surgery physical therapy visit regarding exercises to do at home. You will also be asked to attend a joint bootcamp where you will learn more about your surgery, recovery, and the steps to help you along the way.
  • Eat a balanced, healthy diet high in protein and remain hydrated throughout the months leading up to surgery. Your physical strength before surgery is important to recovering well after surgery.
• Three days before surgery:
  • Apply mupirocin nasal ointment (betadine swabs if you’re allergic to mupirocin). This is done to minimize risk of infection.
• On the night before surgery:
  • Do not eat solid foods after 11 p.m.
  • Shower with Hibiclens® (which you will receive at your clinic visit).
  • You can drink clear liquids (such as water, Gatorade, or Sprite) until two hours before your surgery start time.
• On the day of surgery:
  • Shower with Hibiclens®.
  • Drink either a bottle of water or 20 ounces of Gatorade on the way to the hospital, at least two hours before your surgery start time.
  • In the pre-op area, you will receive non-narcotic pain medications (celecoxib and acetaminophen) to reduce your postoperative pain. If you are at high risk for nausea, you might be given medicines before surgery to decrease this risk.
  • Most patients receive a nerve block before surgery. The nerve block uses local anesthetic to decrease your pain after surgery.

During Surgery

• You will receive either spinal anesthesia or general anesthesia.
  • With either option, you will be comfortable and “sleeping.”
  • Unless you have back problems, blood clotting problems, major heart problems, or are on blood thinners, a spinal would be the preferred option.
• Your anesthesia team will monitor you very closely during the surgery and will insert additional intravenous (IV) lines if necessary.
• You will receive multiple medications during surgery to treat pain and nausea.
• There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain, and accelerate your recovery.

Post-Anesthesia Care Unit (PACU) and After

• You will wake up in our Post-Anesthesia Care Unit (PACU).
• Physical and occupational therapy will be an essential part of your recovery. When possible, you will start physical therapy on the same day as your surgery.
• Beginning on the day of surgery, it will be important for you to get out of bed and walk with help from your nurse or therapist.
• Unless instructed otherwise by your nurse or surgeon, you should be able to eat a normal diet a few hours after surgery.
• You will take scheduled non-opioid pain medications during your recovery and have narcotic medications available for breakthrough pain, if necessary.