• Arrange for a family member or friend to accompany you to the hospital the day of your surgery to stay with you the first night you return home or to the hotel.
• Cancel any dental appointments that fall between 3 weeks prior to surgery and three months after surgery.
• Avoid any injections into your surgical joint for 3 months prior to surgery.
• You will be discharged from the hospital as discussed previously, so plan ahead for transportation home or to the hotel the day of your planned discharge.
• Adjust your work/social schedule accordingly during your anticipated recovery time.
• Remove small throw rugs or other small obstacles that may be in your path.
• If you have pets, you may want to arrange for someone to assist in caring for them for a few days after you return home.
• While taking narcotic pain medication you will NOT be permitted to drive. You may need to arrange for transportation to your initial follow up visit.
• You will need to follow up with Dr. Berger approximately three weeks after surgery. This appointment may have been made for you when you signed up for surgery. If you  were not given an appointment, please call Andrea at 312.432.2343 or Arisha at 312.432.2322
• If you are scheduled for another surgery in 6 weeks with Dr. Berger, your first post-operative appointment is already scheduled for you in three weeks. Refer to your letter in the front pocket of your binder.
• Out-of-state patients will need to see one of Dr. Berger’s nurses before traveling home.
• Ensure you are adequately hydrated after surgery drinking plenty of water or electrolyte beverages.

What to do the day of Surgery

• Take medication as instructed by Dr. Berger’s staff or your internist and arrive at your designated facility as instructed.

RUSH Tower is located at:
1620 West Harrison
Chicago, IL 60612

Registration is on the 1^st floor of the RUSH Tower. You can be dropped off at the base of the building, valet park, or park in the parking garage and take the walkway on the 4^th floor from the garage to the hospital. Take your parking ticket with you, as it will be validated on your surgical day.

If you have questions about parking at the medical center, you may call the parking office at 312.942.6594

Munster Surgery Center is located at:
9200 Calumet Avenue Suite S-100
Munster, IN 46321
219.595.0789

North Shore Surgical Suites is located at:
8400 Lakeview Parkway Suite 800
Pleasant Prairie, WI 53158
262.455.7548

Rush Oak Brook Surgery Center is located at:
2011 York Road, Suite 3000
Oak Brook, IL 60523
630.472.2245

What do I need to bring with me the day of surgery?

• Photo ID and Insurance card
• Cane or crutches; if you do not have these devices, they will be given to you the day of surgery by the physical therapist
• Dress appropriately
  • Loose-fitting pants, with an elastic waist band
  • Shoes with a non-skid sole, that you can easily put on, keeping in mind that swelling may be present
• Friend or Family member

What should I leave at home?

• Jewelry
• Money/valuables
• Contact lenses
• Medications

PREOPERATIVE EXERCISE PROGRAM

• If you are currently performing an exercise program, continue doing so.
• If you are not currently performing an exercise program, you may incorporate exercises as directed on the hand-outs in your binder. If you attempt the exercises and find them too painful, stop doing them.
• After surgery, your physical therapist will give you an exercise program and progress you appropriately.

Therapy in the Hospital

• All patients will receive physical therapy before being discharged from the hospital. The session will consist of getting in/out of bed, standing, walking and going up/downstairs.
• Friends and family are encouraged to attend your physical therapy session with you.
• You will be allowed to put full weight through your leg.
• You will leave the hospital with a cane. At some point during your hospital stay, you will walk without an assistive device.

What will Physical Therapy be Like After Discharge from the Hospital?

In-home physical therapy

• Dr. Berger’s patient services coordinator, DeAnna, will contact you prior to surgery to arrange your discharge plan. This includes services at your hotel as well as at your home, if applicable.
• Home Health Services will be set up for 3x/week for two weeks or until you are ready to progress into outpatient physical therapy.

Outpatient physical therapy

• You are responsible for setting up your outpatient physical therapy visits.  Select an outpatient facility which is convenient for you and takes your insurance.
• You will be given an outpatient physical therapy prescription from our office; there is also a copy in your spiral bound book.
• You will go to outpatient physical therapy 3 times a week for 6 weeks.
• You should progress yourself into outpatient physical therapy as soon as you meet one of the following criteria:
  • • You have met your goals at home and are discharged from home physical therapy by your therapist
    • You are no longer homebound (i.e. you return to work or start driving)

There are certain positions you want to put your leg into to ensure you receive the maximum range of motion.

Goals to Achieve by 3 Weeks

1. Bend your knee at least 110 degrees (flexion)
2. Straighten knee to 0 degrees (extension)
3. Ambulate at least 2 blocks without an assistive device
4. Independent with activities of daily living (i.e. showering, dressing, etc.)

Dr. Berger will prescribe post-operative medications for each patient after surgery. A multi-modal approach is utilized to adequately control pain and minimize risk factors after surgery for a desirable recovery and ideal outcome.

When you are ready for prescription refills, contact one of the nurses in the office during normal business hours (Monday through Friday, 7 am – 5 pm). Refills can be authorized to your local pharmacy. You will need to provide us with your local pharmacy phone number, the name of the medication you need refilled, and your birthdate.

WEEK 1:

RICE

• R = Rest 
  We want you to be up and moving but do this in moderation. We recommend you rest the first 5-7 days after surgery. DO NOT OVERDO IT. Increased activity means increased swelling. By decreasing the swelling early you will recover quicker. We recommend small bouts of activity throughout the day. Get up and walk around the house a little bit every hour to hour and a half that you are awake.
• I = Ice
  Ice as much as possible the first week to two weeks. ice is a great anti-inflammatory and helps minimize swelling. you may apply an ice massage over the knee, the quadriceps muscle (muscle located on the front of the thigh), the hamstring muscle (muscle located on the back of the thigh) and the calf.
  • • Ice Machine We will provide you with an ice machine the day of your surgery. The ice machine is yours to keep and you will not be billed for the machine. you may use the machine as much as you like as long as there is a barrier between your knee and the wrap from the ice machine (an empty pillow case or small towel works well). *If you are having 2 knee surgeries with Dr. Berger please bring the ice machine back to the hospital for your second surgery. Please label it with your full name. **If you have problems with your ice machine, please contact the company directly.  The phone number is part of your purple discharge instructions. 
• C = Compress
  The TED hose compression stockings provide compression and help minimize swelling. Keep the stockings on during the day and take them off at night for the first 3 weeks after your surgery. The stockings go on both legs.
• E = Elevate
  Elevating your leg will help reduce swelling.To reduce significant amounts of swelling elevate your leg 4-5 times a day for 15-30 minutes each time. Do this by lying flat with the ankle above your knee and your knee above your heart.

WEEK 2:

• You may start using heat to help decrease bruising. Place a hot pack/heating pad over the front and back of the thigh (quadricep and hamstring muscles) and on the calf muscle. Try heat 3 times a day for 20 minutes each time. Using heat will increase your flexibility and make exercising easier. Alternate the heat and ice. Heat before you stretch/exercise and use ice after activity.
• Start outpatient physical therapy.
• Focus on range of motion, exercises, initiate strengthening, and increase walking distance.
• Return to driving.

WEEKS 3-6:

• Ease into physical activity.
• Continue outpatient physical therapy.
• Return to work.
• Significant reduction in swelling.

IF YOU HAVE CONCERNS/QUESTIONS, PLEASE READ THE FOLLOWING INFORMATION BEFORE CALLING THE OFFICE.

What if my leg swells after surgery?

It is very common to experience swelling after surgery. Sometimes, you will not swell until several days after your surgery. Remember that your body is healing from the surgery and some swelling is normal. The more activities and physical therapy you perform, the more swelling you may experience.

With that said, we do want you to remain active and participate in therapy. But, when sitting and resting, you can decrease the swelling by elevating your surgical leg and using ice. It is important to elevate your leg, with your knee above the level of your heart, 4-5 times a day for 15-30 minutes each time to help reduce your swelling. Your toes should be above your nose!

You should be alarmed if you have swelling for several days that is accompanied by redness and heat or coolness in your surgical leg, or if the swelling does not resolve after elevating. If this is the case, please contact Dr. Berger’s office.

Will I have bruising after surgery?

Yes, you will have some degree of bruising after surgery, but everyone is different. Some will only experience redness around the incision; others will have bruising down the entire leg. Both are considered normal and will resolve over 10-14 days.

What should I expect my activity level to be?

Every patient is different. Every day you should be increasing your activity level, but let your pain level and swelling be your guide. You will make 90 percent of your recovery in the first four to six weeks, and the remaining ten percent will come within the next year.

At some point, most patients overdo with activities and therefore take a few steps back in their recovery. You may have increased swelling or discomfort if this happens. You need to become concerned if you cannot control your pain with rest and pain medications, or if you have difficulty bearing weight through your surgical leg.

What if I am having problems sleeping?

Make sure that your pain is well controlled throughout the day. During the day be careful about taking naps. Try to plan your activities as near normal as possible. If you continue to have issues, please call one of the nurses to discuss.

How much weight can I put through my leg after surgery?

Put as much weight as you can tolerate through your surgical leg immediately after surgery. The term is “weight bearing as tolerated.” Your physical therapist will instruct you on how to use your crutches or cane in order to perform this properly.

When can I shower or bathe?

You can shower the day after surgery. To ensure that your incision heals properly, we do not want you to bathe or get into a swimming pool for 10 days. If you have scabs on your incision after that time, you may not get into a pool until it is healed.

What about using a hot tub or whirlpool?

Because of the heat and bacteria in the water, we do not want you to use a hot tub or whirlpool for six weeks.

How long do I have to wear the stockings?

You should wear them for three weeks. During the three weeks you must wear the stockings during the day, but may remove them at night. These should be worn on both legs after surgery. You will be issued an extra pair before you are discharged from the hospital.

I just had a knee replacement. What positions can I sleep in?

You may sleep in any position you are comfortable in. Ensure that your leg is kept in a straight position without anything under your knee.

When can I restart the meds I was told to stop prior to surgery?

Usually as soon as you are discharged from the hospital, but check with Dr. Berger’s office if there are any medications in question.

Now that I am no longer requiring narcotic pain medication, what can I take if I should experience discomfort?

You may take Tylenol or Extra-Strength Tylenol. Because you are already taking an anti-inflammatory (Voltaren), you may not take over the counter medications, such as Advil or Aleve (Ibuprofen).

What should I do if I think my joint is infected?

As stated above, you will experience some bruising and swelling after surgery. In addition, you may notice a small amount of yellowish or pinkish drainage. You should contact the office if you have a large amount of drainage that has saturated through your clothing, if the drainage is yellowish/cloudy or if you are running a consistent temperature of 101.5, or if you have a new onset of pain that is not controlled by your pain medications. These symptoms do not mean that you are infected, but are symptoms we should be notified of.

What should I do to avoid constipation?

You should start your stool softener (Senokot) two days before surgery and continue it twice daily until you have a normal bowel movement or while taking narcotic pain medication. If you are traveling from out of town start the stool softener once you get to Chicago. Stop the stool softener if you start to experience loose or watery stools. If you continue to have symptoms of constipation you can take Milk of Magnesia, which is a mild oral laxative, or use Magnesium Citrate, which is much stronger. In addition, you can also try Dulcolax suppositories or a Fleets enema. All of these medications can be bought over the counter at a pharmacy.

Is it normal to hear clicking in my knee after surgery?

You may hear clicking in the knee after surgery and this is normal. It is usually more noticeable after surgery when you have swelling. As the swelling decreases the clicking may become less noticeable.

Will I be able to kneel after surgery?

You will be able to kneel after surgery. Although it will not damage the prosthesis to kneel, many patients find it mildly uncomfortable to do so. We always recommend placing a cushion under your knee to help alleviate the discomfort.

When should I take antibiotics? Who will give me the antibiotics? How long should I take the antibiotics? You should take antibiotics before the following procedures:

• ANY dental procedure, including teeth cleanings
• Sigmoidoscopy/colonoscopy
• Any infection
• Tonsillectomy
• Bronchoscopy
• Liver biopsy
• Genitourinary Instrumentation
• Prostrate and bladder surgery
• Kidney surgery
• Vaginal exams and GYN surgery
• Barium enema

Please contact the office to obtain the antibiotic from Dr. Berger. You will receive either Amoxicillin or Clindamycin, and the dosage is four tablets one hour prior to the procedure. Do not schedule any of the above appointments starting 3 weeks before surgery up until 3 months after surgery. This is a lifelong precaution.

When to call Dr. Berger’s office:

• Fever above 101.5 consistently
• Increased drainage or swelling
• Pain not controlled by pain medication
• Inability to bear weight on your operative leg
• Severe insomnia
• Swelling in foot or calf that is accompanied by coolness or decreased sensation in foot
• Confusion or disorientation