Recovering from Knee Replacement Surgery
What should I expect after surgery?
After surgery, you will be taken to the Recovery Room for approximately two hours for close observation. Your blood pressure, pulse, respiration, and temperature will be checked frequently. Attention will be paid to the circulation and sensation in your legs and feet. It is important to tell your nurse if you experience numbness, tingling, or pain in your legs or feet. When you awaken and your condition is stabilized, you will be transferred to your room.
Although circumstances vary from patient to patient, you will probably have some or all of the following after surgery:
- You will find that a large dressing has been applied to the surgical area to maintain cleanliness and absorb any fluid. This dressing will be removed within 24 to 48 hours after surgery.
- An IV, started before surgery, will continue until you are taking adequate amounts of fluid by mouth. When you are taking fluids well, the IV may be changed to a Heparin lock, a small sterile tube that will keep a vein accessible for antibiotics and allow for easier movement. Antibiotics are frequently administered every eight hours, for two to three days, to reduce the risk of infection.
- One side effect of anesthesia is often a difficulty in urinating after surgery. For this reason, a sterile tube called a foley catheter may be inserted into your bladder to insure a passageway for urine. It will be removed 24 hours after surgery.
- You will have on intermittent passive compression (IPC) stocking sleeves that are connected to a machine that circulates air in the plastic and around your legs. These stockings are worn on your legs to prevent blood clots from forming after surgery. You will also be given medications and exercise instructions (moving your ankles up and down), which help to prevent clots.
- Post-operatively you may have temporary nausea and vomiting due to anesthesia or medications. Anti-nausea medication may be given to minimize this condition.
- Your diet will progress as your condition permits, starting with ice chips and clear liquids.
- To help prevent complications, such as congestion or pneumonia, deep breathing and coughing exercises are important. After surgery, these exercises are to be done every one or two hours. Inhale deeply through your nose; then slowly exhale through your mouth. Repeat this three times and then cough two times. You will be encouraged to use your inspirex, blowing the ball up the tube by taking deep breaths.
- A metal triangle called a trapeze maybe placed in the overhead bed frame to assist you in moving around the bed. You are encouraged to move in bed without using the trapeze. This will prepare your for independence at home.
Most patients have a moderate degree of discomfort in the knee that is effectively treated with pain medications. The pain decreases over the next week or so, and by about two or three weeks after the surgery, patients are feeling much better.
An epidural or a patient controlled analgesia (PCA) is used for the first two to three days after your surgery. When the epidural or PCA is discontinued, your doctor will prescribe pain medication to be taken by mouth. It is important to continue taking them because preventing pain is easier than chasing it. If you continue to experience pain after taking the medication, we encourage you to notify your doctor or nurse so alternate methods of pain control can be started.
Some patients experience back discomfort after surgery. This is caused partly by the prolonged lack of movement required before, during, and after surgery. Periodic change of position helps to relieve discomfort and prevents skin breakdown.
Patients are usually given blood thinners to prevent blood clots in the leg following the knee replacement. This continues for about three weeks following surgery.
Exercise Therapy and Rehabilitation Program
When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven't used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours.
Physical therapy is started the day after surgery, provided there are no complications. You will walk and be assisted into a chair the first day after surgery. Some physicians recommend that patients use a continuous passive motion (CPM) machine. This is a device that is fit to your leg and is placed in bed with you. It slowly and smoothly bends and straightens your knee. You will use the machine periodically during the day, and it will be adjusted to increase the bend in your knee. However, this is not a substitute for your exercises.
In your physical therapy sessions you will walk, using crutches or a walker, bearing as much weight as indicated by your doctor. You will also work on an exercise program designed to strengthen your leg and increase the motion of your knee.
Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy. You will work with physical therapy until you meet the following goals:
- Independent in getting in and out of bed
- Independent in walking with crutches or walker on a level surface
- Independent in walking up and down three stairs
- Independent in your home exercise program
- Able to bend your knee 90 degrees
- Able to straighten your knee
Your doctor and therapist may modify these goals somewhat to fit your particular condition.
How well you regain strength and motion is, in part, dependent upon how well you follow your physical therapy. This part of your rehabilitation is something that you must do for yourself, and not something someone else does for you. It takes about three months for the knee to recover to a point where patients are back to full activities. Obviously, some patients recover faster and others slower, depending upon age, health status, personal motivation, and response to rehabilitation.
Guidelines at Home
What happens after I go home?
Upon discharge from the hospital, you will have achieved some degree of independence in walking with crutches or a walker, climbing a few stairs, and getting into and out of bed and chairs. However, someone is needed at home to assist you for the next two weeks or until your energy level and mobility has improved.
You may be sent home on prescribed medications to prevent blood clots. Your doctor will determine whether you will take a pill (Coumadin or coated aspirin) or give yourself a shot (Enoxaparin). If an injection is necessary, your doctor will discuss it with you. The nursing staff will teach you or a family member what is necessary to receive this medication.
You will also be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Remember that preventing pain is easier than chasing it. If pain control continues to be a problem, call your doctor.
You will be instructed in a home exercise program designed by your physical therapist. Remember that walking is not a substitute for your exercises.
If an exercise is causing long-lasting pain, you should cut back on your exercises. If it continues to cause pain, contact your physical therapist or physician.
Continue to walk with crutches or a walker as directed by the doctor or physical therapist. Your physician will determine how much weight you can place on your operated leg.
Walking is one of the better forms of physical therapy and for muscle strengthening. However, walking does not replace the exercise program that you are taught in the hospital. The success of the operation depends largely on how well you do the exercises and strengthen weakened muscles.
Are there certain things I need to avoid after my total knee replacement?
Yes, there are a number of things you need to be aware of. Your new knee is designed to eliminate pain and increase function. Certain movements place undue stress on your new knee. For your safety, these should be avoided. This is especially true during the first few months after your surgery.
The following is an outline of the precautions you should follow after surgery:
- Riding in a car is permitted as long as you make hourly stops to get out and walk around.
- Generally, you will be able to resume driving in three to four weeks following surgery. When getting into a car, back up to the seat of the car, sit and slide across the seat toward the middle of the car with your knees about 12 inches apart. A plastic bag on the seat will help you safely slide in/out of the car.
- Sexual activity can be resumed per your physician's instructions.
- You can usually return to work within three to six months or as instructed by your doctor.
- No tub baths, only showers, until staples are removed.
In addition, when visiting physicians and dentists it is important that you inform them that you have a total joint replacement. You will need antibiotics for certain dental and medical procedures; ask your doctor for a medical alert card, if you don't already have one. This precaution is permanent.
Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. When using heat or ice, remember not to get your incision wet before your staples are removed. Generally, the staples are removed in one to two weeks.
Prevention of Infection
If at any time (even years after the surgery) an infection develops, such as strep throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the knee area.
This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement.
When do I return to the clinic?
Your first return appointment is one to three weeks after discharge, at which time you will be examined and have X-rays. Subsequent appointments are then at one month, three months, six months, one year, and two years after surgery. Thereafter, you should return every three years.
Once you return home, if you have any questions or concerns regarding your total knee replacement, please do not hesitate to call. Between the hours of 8 a.m. and 5 p.m., Monday through Friday, please phone your surgeon's office.
After 5 p.m. and on the weekends and holidays, please phone 231-672-3916 and ask to speak to the doctor on call.
Remember: Your physician, physical therapist, and nurses are striving to make a painless, functional knee possible for you. The real success of your knee replacement, however, depends partly on you — especially how conscientiously you exercise and take care of yourself.
Good luck and good health!