Total Knee Replacement: FAQs

FREQUENTLY ASKED QUESTIONS AFTER TOTAL KNEE REPLACEMENT

What is recovery time?

Everyone heals from their surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for 2 to 3 weeks after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices.

How long will I be on pain medications?

You will likely require some form of pain medication for about 2 months. Initially, you will be a stronger medication (such as a narcotic). Most people are able to wean off their strong medication after 1 month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g. aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting your internist.

Do I need physical therapy?

Yes! The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. After discharge, you will be referred to an outpatient physical therapist. If you go to a rehabilitation hospital or ward, you will receive therapy there. The therapist will help you walk, regain motion, build strength, and help you reach your postoperative goals. Your therapist will keep your surgeon informed of your progress.

What exercises should I do?

You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and a stationary bicycle are good exercise options. These exercises should be continued indefinitely, even after your recovery is complete.

What are good positions for my knee? What positions should I avoid?

You should spend some time each day working on straightening your knee (extension), as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you are lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or towel roll behind the knee for any length of time.

Can I use weights?

Generally, not for the first 4 weeks. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with, and gradually progress.

I am constipated. What should I do?

It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking a narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or an enema.

When can I drive?

If you had surgery on your right knee, you should not drive for at least a month. After 1 month, you may return to driving as you feel comfortable. If you had surgery on your left knee, you may return to driving as you feel comfortable, as long as you have an automatic transmission.
DO NOT DRIVE IF TAKING NARCOTICS!

When can I return to work?

This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately 3 to 4 weeks. If your work is rigorous, you may require up to 2 to 3 months before you can return to full duty. In some cases, more time may be necessary.

When can I travel?

You may travel as soon as you feel comfortable. It is recommended that you get up and stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.

What activities are permitted following surgery?

You may return to most activities as tolerated, including walking, gardening, hiking, and golf. Some of the best activities to help with motion and strengthening are swimming and riding a stationary bicycle.

What activities should I avoid?

You should avoid impact activities such as running and vigorous racquet sports, such as single's tennis or squash.

Can I have sex?

Yes, as soon as you are comfortable.

Can I drink alcohol?

If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should also avoid alcohol if you are taking narcotics or other medications.

Should I use heat or ice?

Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.

Can I go up and down stairs?

Yes. Initially, you will lead with your non-operated leg when going up stairs, and lead with your operated leg when going down stairs. You can use the phrase, "Up with the good, down with the bad" to help you remember. As your leg gets stronger, you will be able to perform stairs in a more regular pattern (about a month).

Can I kneel?

After 2 months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets.

How much range of motion (ROM) do I need?

Most people require 70 degrees of flexion (bending the knee) to walk on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs, and 105 degrees to get out of a low chair. Your knee should also come to within 10 degrees of being fully straight to function well.

Do I need antibiotics before dental work or an invasive procedure?

Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or non-urgent procedures for 6 weeks postoperatively.

I feel depressed. Is that normal?

It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.

I have insomnia. Is this normal? What I do about it?

This is a common complaint following knee replacement surgery. Nonprescription remedies, such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.

How long will my total knee replacement last?

This varies from patient to patient. For each year following your knee replacement, you have a 1 percent chance of requiring additional surgery. For example, 10 years postoperatively, there is a 90 percent success rate.

When do I need to follow up with my surgeon?

Most patients are discharged from the hospital on the third or fourth postoperative day. Follow-up office visits are routinely advised for:

1. 1-2 weeks after surgery for staple removal.
2. 4 weeks after surgery for an x-ray and exam of knee motion.
3. 3 months after surgery for exam and assessment of activities.
4. 6 months, 1 year, and annually thereafter for x-ray and exam.

Please call our office appointment desk to schedule appointments: 425-656-5060

I'm out of pain medication.

Refills for pain medicines may be obtained by contacting our office during business hours. It is the policy of our office that narcotic pain relievers will not be refilled or phoned in after hours or on the weekends. Prescription anti-inflammatories may be resumed 48 hours following the last Coumadin dose.

Normal things about your new knee:

• Clicking noise with knee motion.
• Skin numbness on the outer (lateral) part of your knee.
• Swelling around the knee and/or lower leg.
• Warmth around the knee.
• "Pins and needles" feeling at or near your incision.
• Dark or red incision line. This will gradually fade to a lighter color.
• Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.

Abnormal things about your new knee:

Call the office immediately, if you experience any of these.

• Increased bruising, if on Coumadin.
• Increasing redness, particularly spreading from the incision.
• Increasing pain and swelling.
• Fevers > 101 degrees F.
• Persistent drainage from your wound.
• Calf swelling or pain, particularly associated with ankle motion.
• Ankle swelling that does not decrease or resolve overnight.

Unicompartmental or Partial Knee Replacement

Frequently Asked Questions Prior To Unicompartmental (Or Partial) Knee Replacement

What is a partial or unicompartmental knee replacement?

This is a surgical procedure performed through a relatively small incision, which resurfaces only the worn-out compartment of the knee joint. Both the femur and tibia on the involved side of the knee are resurfaced with metal and plastic components. These are fixed to the bone with bone cement.

Is there an advantage compared to total knee replacement?

A unicompartmental replacement utilizes a smaller incision, results in a shorter hospital stay with a faster recovery period. There is better range of motion and a more normal feel to the knee. Conversion or revision of a failed unicompartmental replacement is easier than a revision of a total knee replacement.

What are the disadvantages?

This procedure is indicated in fewer individuals with arthritis when compared to a total knee arthroplasty. The durability of a partial knee replacement is somewhat less than a total knee replacement with a failure rate at 10 years follow-up for partial knee replacement of approximately 10 percent, compared to a failure rate of total knee replacement of approximately 5 percent.

How long will I be in the hospital?

Typically, one to two days, depending on your level of discomfort.

What do I need to do before surgery?

You will need to have a preoperative medical evaluation from your internist or primary care physician. You will need to see the preoperative nurse at Valley Medical Center and attend a seminar at the Joint Replacement Center.

When do I get admitted to the hospital?

You will come to the hospital two hours priori to your procedure. You will meet the anesthesiologist, who will discuss anesthetic options including a spinal versus general anesthetic. These will be supplemented by a femoral nerve block, which aids in postoperative pain relief.

How long does the surgery take?

The procedure generally takes 60 to 75 minutes.

What happens after surgery?

You will be in the Recovery Room following surgery. You will have an IV in your arm and an Ace wrap on your knee. You may or may not have a drain, which will be removed in 24 hours.

The remainder of your hospital stay:

After the Recovery Room, you will be transferred to the Center for Joint Replacement. The day of surgery, you will get up and begin walking in your room, putting as much weight as you are comfortable on your knee using a walker or crutches. You will begin range-of-motion exercises and apply ice to your knee. You will receive therapy twice a day until you are discharged home, one to two days after surgery.

Will I go to therapy after surgery?

Yes. You will attend therapy two to three times a week for three to six weeks, depending on your progress.

Will I use a walker or crutches?

You will use a walker or crutches for roughly five to seven days after surgery, then advance to a cane as tolerated.

When do my stitches come out?

Seven to 14 days. Steri-Strips will be placed over your incision.

When can I shower?

Two days following surgery.

What is the recovery time?

Everyone heals from surgery at a different pace. In most cases, you will be up and walking without support by two to four weeks after surgery. You will steadily increase weekly thereafter and continue to improve for six to 12 months after surgery.

When can I drive?

Three to four weeks for a right unicompartmental replacement, and after a left unicompartmental replacement, when you are comfortable.

Normal things about your new knee:

• Clicking noise with certain motions of the knee.
• Skin numbness on the outer (lateral) part of your knee.
• Swelling about the knee or leg for several weeks following surgery.
• Warmth about the knee for two to three months after surgery.
• "Pins and needles" feeling at or near your incision.
• Bumps under the skin along your incision. Occasionally, the sutures used to close the wound can be felt under the skin.

Abnormal things about your new knee:

• Call the office immediately (426-656-5060), if you experience any of these:
• Increasing redness, particularly spreading from your incision and/or drainage after five to seven days following the surgery.
• Increasing pain and swelling.
• Fevers greater than 101 degrees F.
• Calf swelling or pain, particularly associated with ankle motion.