Knee Replacement Recovery Guide Table of Contents Congratulations!... 2 Recuperating At home... 2 Range of Motion... 2 Wound Care... 3 Important Signs & Symptoms... 3 Bathing and Showering... 3 Bruising... 4 TEDS/ Support Hose... 4 Weight-bearing and Assistive Devices... 4 Preventing Falls... 4 Getting comfortable / Pain Management... 5 Constipation Care... 5 Driving... 5 Notify All Providers... 5 Follow Up Appointments... 6 Metal Detectors... 6 Cold Therapy (Ice)... 6 Home Exercises Knee... 7 Questions or Problems... 8 1
Congratulations! Congratulations on your new knee! We encourage you to work hard during your recovery period. We hope that you will have excellent results so that you will be able to participate in the activities that you enjoy! Most joint replacement patients do very well following surgery experiencing no complications. The success of your surgery can depend on recognizing and preventing potential complications. Recuperating At home Change does not happen overnight, and your active participation in the healing progress is necessary to assure a successful outcome. While you can expect some good days and bad days, you should notice gradual improvement over time. It s important to stay active. The key is to not overdo it. Ask for help when you need it. Whether you are discharged home with VNA services or to a rehabilitation facility, it is important to review the following information. When you go home with VNA services, a nurse will call you the following day to set up a time to visit you at home. Range of Motion The rehabilitation process after a knee replacement takes time, patience, and motivation. We encourage you to be consistent and compliant with physical therapy and the home exercises that you have learned. It is important to work on range of motion exercises after surgery. We would like you to work toward full extension of your knee (completely straight) and 90 of flexion/bending by approximately one week after surgery. Our goal is for you to achieve full extension and approximately 120 of flexion (measured by your physical therapist) after completing physical therapy. It is important that you do not place pillows or anything under your knee while you re resting. You should place something under your heel to allow gravity to stretch your knee to full extension. Although you will most likely have physical therapy at home, and in an outpatient setting, it is still your responsibility to consistently work on home exercises to achieve your goals. 2
Wound Care Knee Replacement Recovery Guide It is important that you take proper care of your incision to avoid infection. There will be staples along the incision that will be removed at the first follow-up visit with your surgeon, between 10 and 15 days after your surgery. Here s what you need to know: Proper care of your incision will help prevent infection. Most patients with knee replacement notice areas of decreased sensation (numbness) on the outer part of the knee. This is a normal result after knee replacement. You will leave the hospital with a waterproof dressing over your incision. You may also be wearing support hose (TED hose) for comfort and to control swelling. When you remove your stockings at night you may use an ace wrap around your knee to keep the gauze (do not use tape) on your incision. Do not apply the Ace wrap too tightly around your knee. Continue this preparation at home until you no longer have any drainage. Then you may leave your incision uncovered. You may experience some swelling in your surgical leg. Elevate your surgical leg and apply ice to help reduce swelling. Do not use any soaps or lotions on the incision. Important Signs & Symptoms Warning signs of a possible joint replacement infection include: Persistent fever of more than 100.5 F. Chills Increase in redness, tenderness, swelling or warmth around the incision. Bloody or yellow/greenish drainage from your incision. Increase in pain with both activity and rest. Notify your surgeon if you develop any of the signs. Bathing and Showering As long as your incision is not draining, you may shower with assistance after 7 days. Allow the water to run over (do not scrub) the incision, don t let your incision becomes saturated. After showering, pat (do not rub) your incision dry. You should not bathe, swim, or submerge the leg in water until your surgeon has cleared you for that activity. 3
Bruising Bruising may develop on the operative leg. The bruising and swelling may even extend to the ankle which is normal. This will improve with time. TEDS/ Support Hose You should wear support hose that will be put on at the hospital. You should continue to wear them at rehab and possibly at home, if you have someone to help you put them on. If you have assistants to put them on and you find the hose to be helpful for controlling your swelling you may continue to use them. They should be removed at night. Weight-bearing and Assistive Devices Weight-bearing and movement precautions depend on how your surgery was performed. Your physical therapist will help to advise you regarding progression from the walker to a cane. You may progress to a cane when you feel comfortable and safe. Hold your cane in the opposite hand from the knee that was replaced. Some people need to use a cane for up to six weeks after surgery. You should continue to use a cane until your walking pattern returns to normal. Safety is a very important factor in your healing process, as avoiding falls is necessary. Another important reminder your physical therapist should review with you is walking with a heel to toe pattern. Preventing Falls A fall after surgery can damage your new joint replacement. Follow the precautions provided to you by your therapist. Remove scatter rugs and electrical cords that could cause you trip. Wear shoes with rubber soles for good traction. Get up slowly from a chair or bed in case you are dizzy. Remove anything that could block your way while walking. Use your walker, crutches or cane as instructed by your physical therapist 4
Getting comfortable / Pain Management Joint replacement patients have different needs for pain medication following the return home. As time goes by, you will need less and less pain medicine. It doesn t take long before most patients are able to switch from a narcotic to an over-the-counter pain medication, and stop using pain medication altogether. Your doctor will guide you through this transition. Constipation Care The pain medication we prescribed can cause constipation. Drinking plenty of fluids will help. You also may need to take a stool softener or a laxative. Driving YOU SHOULD NOT DRIVE UNLESS YOU HAVE BEEN GIVEN INSTRUCTIONS TO DO SO FROM YOUR SURGEON. Driving is a variable situation after surgery. Your surgeon will take into consideration the following things before releasing you to drive: You may not operate a motor vehicle while taking a prescription (narcotic) pain medication. You should also feel comfortable walking with a cane or without an assistive device before considering returning to driving. You need to use common sense and feel sure that you have adequate control and strength of your leg to be a safe driver. You should wait to drive until you feel absolutely safe behind the wheel. Generally we suggest that patients who have had a right total knee arthroplasty wait 6 weeks before driving. Patients who have had a left total knee arthroplasty should wait approximately 4 weeks. Notify All Providers PLEASE NOTIFY ALL OF YOUR PROVIDERS ABOUT YOUR JOINT REPLACEMENT FOR INFECTION PREVENTION 5
It is uncommon for new joints to become infected during or immediately following surgery, but it can happen at any time in the future. An infection in some other part of your body can spread to your new joint, causing it to become infected. Please tell all of your health providers that you have a joint replacement so antibiotics can be prescribed for any medical treatment, if needed. This is especially important before dental procedures or invasive urinary procedures. Hand washing is the most important step in preventing infection. Follow Up Appointments Your first follow-up appointment will be between 10 and 15 days after surgery. You will either see your surgeon or his/her physician assistant at that visit. Your staples will be removed at this visit. Outpatient physical therapy will usually start as soon as possible after this postoperative visit. The second follow-up visit is approximately 6 weeks after surgery. At the six-week post operative visit, x-rays of your knee replacement will be obtained for your surgeon to review with you. Your next follow-up visit is usually 3 to 4 months after surgery depending on your progress. You should return one year after surgery and every 2 to 3 years after that for surveillance x-rays. Metal Detectors Because your new joint contains metal, it is likely that you may set off metal detectors. The most common places are the airport, public buildings, such as pharmacies, court buildings, and schools. If you set off the metal detector at the airport, you may have to undergo further inspection, so give yourself a little more time to get through security. Cold Therapy (Ice) To help keep comfortable and ease swelling, apply ice (cold therapy) on the procedural area for 20 minutes at a time, 3-4 times per day. In order to prevent a cold "burn," remember to wrap the ice in a towel so that it is not placed directly on your skin. Reusable ice packs can be purchased at your local pharmacy, and we suggest having a few on hand so that you can rotate throughout the day. Bags of frozen vegetables, such as peas, also work just as well. 6
Home Exercises Knee Please review the following reminders prior to starting your home exercise program: Continue to use your walking device (crutches, cane or walker) until otherwise instructed by your physical therapist or surgeon. Do not keep your knee in the same position (either out straight or bent) for extended periods of time (more than one to two hours). When lying in bed, do not place a pillow under your knee. Continue with the pre-surgery exercises you began prior to surgery. TERMINAL KNEE EXTENSION Lie on your back. Place a towel or blanket roll under your knee. Keep the back of your knee in contact with the roll and lift your foot off the bed and straighten your knee. STRAIGHT LEG RAISING Lie on your back with the non-operative leg bent. Start by doing a quad set on the operative leg. Hold the quad set and lift your leg off the bed, keeping the knee straight. LYING HEEL SLIDES Lying on your back, bend your knee up, sliding your heel on the bed. BELLY LYING HAMSTRING CURLS Lying on your belly, legs out straight, bend your knee, lifting your foot off the bed toward your buttock. SITTING KNEE FLEXION STRETCH Sitting in a chair or on the side of a bed, bend your knee and bring your foot back as far as you can. You may cross your opposite foot in front and give a gentle stretch to the bent knee. SITTING KNEE EXTENSION Sit in a chair, with the leg slightly out in front, with the foot resting on the floor. Straighten the knee by keeping the thigh on the chair, tightening the quad muscle, and lifting your foot off the floor. 7
SOUTH SHORE ORTHOPEDICS TEL 781-337-5555, FAX (781) 335-6047 Two Pond Park, Suite 102, Hingham, MA 02043-4309 Questions or Problems A great way to ask a question s about problems, or concerns about your recovery after the knee replacement is by using the comment section in HealthLoop, calling our office at 781 337-5555. It is important that you notify other healthcare providers that you have a knee replacement, since you may require antibiotics prior to procedures. 8