Total Knee Replacement: Post-Op Resources

After Discharge From The Hospital

If you live alone or do not have adequate help, you may go to a rehab facility for a while following surgery. We will discuss options for your care prior to your hospital admission. Whether at a rehab facility or at home, the following things are important for your care:

• Knee Immobilizer: The knee immobilizer (splint) is to be worn two weeks to maintain extension while sleeping. Knee splint is not to be worn during the day.
• Your Knee Incision: Staples will remain in place for one to two weeks. They will be removed in your surgeon's office at first postop visit. Steri-Strips will be applied, which can be removed in one week.
• Ice and Elevation:We encourage the application of ice packs following exercise and at least three times per day for 30 minutes at a time when resting with the foot and leg elevated on three pillows (at least 18 inches above the level of your heart). An easy schedule to follow is 10:00 am, 2:00 pm and 6:00 pm. This elevation is important. It helps reduce swelling and promotes better circulation.
• Swilling/Bruising:: You are likely to see more swelling and discoloration on the outside portion of the knee. This is expected but can be reduced by lying down with leg elevated as described above.
• Walker/Crutches:A walker or two crutches will be used to walk in two to three weeks. This is usually full weightbearing. Progression to a cane can begin at three weeks as pain allows. You should use the cane until you can walk without a limp. This usually takes two weeks.
• Supervised Physical Therapy: Following discharge from the hospital, you will begin outpatient physical therapy two to three times per week for four to eight weeks. This will allow you to work with a therapist to maximize your range of motion and strength. This is very important to the success of your knee. You will perform exercises three times per day, seven days a week, for the first six to eight weeks after surgery.
• Showering/Bathing: Showering is permitted as soon as the incision is free of drainage, usually by two to three days following surgery. You may shower and let the water run over the incision and then pat it dry with a towel, no rubbing. Immersing the leg in collected water such as a bathtub, hot tub or swimming pool is not permitted until 72 hours after the staples have been removed. A dry layer of gauze may be applied to cover the incision if desired. No ointments, lotions or oils are to be applied to the incision until the staples are removed.
• Coumadin: : Most patients will be taking Coumadin for 14-21 days following discharge from hospital. This blood thinning medication is used to help prevent blood clots. A prescription for a specific dosage and time period is given to you at the time you leave the hospital. Your dose will be adjusted by the anti-coagulation clinic at VMC where weekly blood draws will be performed. Aspirin and arthritis medications MAY NOT be taken until 48 hours after the prescription has been completed. If you take aspirin for cardiac reasons, continue to do so while on the Coumadin. Tylenol or Tylenol ES every four to six hours may be used for pain relief in addition to the prescription narcotic analgesics (commonly Vicodin, Darvocet-N or Tylenol w/ codeine). Following the completion of the prescribed Coumadin, you should take one aspirin each morning for one month. Mark this on your calendar.

UNDERSTANDING THE RISKS

As with any surgery, there are certain risks. The following are some of the more common complications of which you need to be aware and things we do to try to prevent them.

• INFECTION: There is always a risk of infection with any surgery. You will receive antibiotics in surgery and several doses after surgery to reduce this risk. The risk of infection after Total Knee Replacement is approximately one percent.
• BLOOD CLOTS: When you have surgery on the knee, circulation is impaired during healing. A blood thinner medication will be prescribed for you, which will help to keep your blood a little thinner than normal to prevent blood clots. We begin the first dose on the evening of surgery. Each day in the hospital, blood will be drawn to check your blood thinning level. Another thing that will help to prevent blood clots is to elevate both feet while sitting to prevent blood pooling in the lower legs and perform ankle-pumping exercises.
• PNEUMONIA: Breathing deeply after surgery and using an incentive spirometer are very important to prevent congestion in the lungs, which can lead to pneumonia. It is very important that you are up and out of bed often.
• BLADDER INFECTIONS: Bladder infections are more common when you have had a catheter. It is very important to drink a lot of fluids to help prevent an infection.
• NUMBNESS AROUND THE KNEE: It is important to know that you will experience some numbness on both sides of your knee. This is not a problem; it is very normal. During surgery the nerves around your knee are disturbed. You may feel tingling sensations as the nerves are healing. You may always feel some numbness around your incision, but this will not affect the function of your new knee. Rarely there can be permanent numbness or weakness as a result of trauma to the nerves.
• STIFFNESS: In the early postoperative period, all patients with a total knee replacement experience pain and stiffness of the knee. Pain medication will ease the pain, but it is very important that you work to increase your motion daily. You will not damage your knee by working to increase motion, despite the soreness.
• SEVERE COMPLICATIONS: Again, with any major surgery there is a possibility that any of the above complications, as well as problems with anesthesia, could be severe enough to result in death. If there are any questions or concerns regarding these complications, please feel free to discuss them with your surgeon.