Total Knee Arthroplasty Post Operative Care

Total Knee Replacement is a resurfacing of the knee with metal and plastic components which are inserted through a front of the knee incision to remove the diseased cartilage. It is designed to relieve weight bearing pain, re-balance the knee, and improve knee function. The procedure is performed on an inpatient basis and most patients are discharged in 3-4 days but may be shorter or longer depending on your specific needs. You will require someone at home to assist you initially after discharge.

We will try to schedule your first post-operative visit about 10-14 days from your surgery so the wound can be checked and sutures removed if appropriate. Call the office at 970-879-BONE (2663) to schedule this appointment.

Incision Care:
The incision will be 6-8 inches in length, is sutured with either absorbable suture or staples and covered with a gauze dressing. You may change the gauze dressing as needed to keep the dressing Clean and Dry. (Remove dressings carefully to avoid skin abrasions). You may shower after you leave the hospital and can leave the wound uncovered while you shower.

DO NOT SUBMERGE YOUR SURGICAL INCISION UNDER WATER (hot tub, bath tub, lake, pond, river, etc).

Any wound drainage should be reported to our office. After the staples are removed steri-strips (white tapes) are usually applied. These usually fall off on their own in 3-5 days and can be removed after five days if they haven’t fallen off already. You may apply Vitamin E or some moisturizing lotion to the incision after the steri-strips are removed. Some swelling and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, contact your surgeon immediately. Bruising around the thigh/knee area is quite normal, this is a result of the tourniquet used during surgery. This may extend down the leg to the shin and ankle/heel area and will usually resolve in a few weeks.

Medications:
Usually we will prescribe Hydrocodone or Oxycodone. These are both generic names for two different narcotic pain relievers. Then use the Oxycodone for breakthrough pain. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Aleve, Nuprin, etc.). The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. If you decide to use over the counter anti-inflammatory medicine, please advise us and also follow the instructions as written on the bottle. You will find that the
combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid using an anti-inflammatory. Plain tylenol is OK if you have no liver disease.

Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If you have a history of nausea with surgery we can prescribe a anti nausea medication (Phenergan). Try to take this medication regularly at first and about 20-30 minutes prior to taking the narcotic pain pills to allow it to be most effective.

Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I can not provide refills after business hours or on weekends.

Swelling:
Again, swelling around the knee and down the leg to the foot and ankle region is very normal. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling. Wear the white TED stockings for 2 weeks after surgery. For the first couple weeks when you go to bed, elevate your leg on 1-2 pillows (so that the knee is above the level of your heart). Also 3 or 4 times during the day, lie flat on your back with your leg above the level of your heart (on 1-2 pillows) for 1/2 hour. The ice should be replaced every 2-3 hours for the first 24 hours. (Not necessary to change as often during sleep hours.) After the first 24 hours apply refreshed ice pack on the knee, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2-3 weeks after surgery. If you feel the swelling is excessive you should call the office. Some patients inquire about ice machines that us water to continually cool the knee. There have been many problems with these devices and Dr. Sarin will not prescribe them. If this is something you definitely want, you will need to contact the company yourself.

Walking:
Upon discharge from the hospital you will be walking with the assistance of a walker or crutches. Generally walking and bending the knee is good, pain or discomfort will limit your activity. You may discontinue using the walker or crutches when you feel comfortable and walk without a limp. This is usually done with the help of your therapist and they will help you progress to the next level of assistive device (walker,crutches,cane,etc). On the average within 3-4 weeks (may use a cane or single crutch if desired). You may go up and down stairs as needed and physical therapy will help with some techniques.

Exercise:
In order to reduce stiffness and obtain maximum function of your knee, it is important to maintain a good balance of rest and exercise. Listen to your body; too much activity will produce increased swelling and/or pain; too little activity could prolong your recovery and/or limit your knee mobility. The physical therapist should provide you with leg and knee exercises to do at home when not in physical therapy. To promote circulation, remember to do your ankle / foot stretching exercises regularly.

General Expectations:
These are averages, remember that each case is individualized, depending on your general health, age, and attitude. For 3-4 weeks after surgery, your activity level is usually limited, however you will be able to walk independently and use bathroom and kitchen facilities. Within 6 weeks you will have resumed more of your normal activities.  Squatting and kneeling come with time. You should never kneel with your weight completely on the kneecap due to the resurfacing of the kneecap and potential to break it. Complete surgical wound healing takes 6-8 weeks. During this time some swelling and discomfort is normal and should be manageable with the prescribed medications.

After this time the knee tissues begin to soften and become more natural. Some patients may notice a small area of numbness on the lateral aspect (outside area) of the knee incision. This usually completely resolves over time but a small percentage of people may have a very small area of numbness around the incision itself.

Important Notice: You will require an antibiotic prophylaxis prior to having any dental work or invasive procedures done. This includes routine cleaning. Please let your dentist know you have a knee implant at the time you make the appointment with him/her. Usually your dentist can prescribe this medicine but if there are any concerns we can prescribe them for your dental procedure.

If you then still have any questions or concerns please notify us at 970-879-BONE(2663)

For all medications to be taken at home, please see your discharge home medication sheet.