Knee Replacement Guidebook
At Home After Surgery
Knee Replacement Guidebook Home | Getting Ready for Surgery | What to Expect the Day of Surgery | Physical & Occupational Therapy | At Home After Surgery
Now that your surgery is done, your focus should be on healing. If you follow the recommendations listed in this section, you will help ensure that your new hip will last for the rest of your life.
When you first get home
- Continue to use your walker and crutches as instructed.
- Continue your set of fifteen essential exercises (see Physical & Occupational Therapy)
- See a physical therapist two to three times a week at home first, then at an outpatient facility for the next one to two months.
- DO NOT swim, use hot tubs, or take tub baths until your surgeon gives you the go-ahead.
- DO NOT USE ointments, lotions, oils or vitamin preparations on your incision until after your first follow-up appointment.
- Wear your elastic stockings until your first follow-up visit.
- Apply an ice pack to your knee dressing(s) for a minimum of twenty minutes, twice daily to decrease pain and swelling.
- Be sure to take your pain medication with food to avoid nausea.
- To help your wound heal faster, continue your healthy eating habits, give up smoking (if you haven't already), and, if you are diabetic, maintain control of your blood glucose level.
- Do not allow pets to share the space where you are sleeping and resting; they can infect your incision.
- To reduce the chance of getting an infection, make sure you and your caregiver wash your hands thoroughly when:
- They are visibly soiled
- Before and after care of your incision
- Before eating
- After going to the bathroom
- After handling or caring for pets
How to use the shower
- Your surgeon will want you to cover your incision when showering until it is completely healed. This is usually until about 24 hours after your staples or stitches are taken out (about 10-14 days after your surgery).
- It is safest to sit while taking a shower.
- Pat your incision dry after showering.
Using the toilet
- Carefully lower yourself onto the seat using the support of your walker or toilet seat frame.
- Keep your surgery leg straight out in front of you.
- The safest way to clean yourself after a bowel movement is to stand and lean forward slightly onto your walker for balance while reaching around to wipe.
- Do not twist your body.
- Keep your legs shoulder-width apart to keep your balance steady.
Your pain medications
- Commonly-taken narcotic pain medications include:
- Oxycodone/Hydrocodone
- Oxycontin (the sustained-release form of oxycodone)
- Dilaudid/Hydromorphone
On occasion, your surgeon may have you take non-steroidal anti-inflammatory medication (NSAIDS); however, do not take it if it is not prescribed for you until you discuss it with your surgeon at your first follow-up visit.
PLEASE NOTE:
The medications you are prescribed should not cause narcotic addiction since you will only be using them for a brief time to relieve genuine surgical pain. However, if you have concerns about addiction, please discuss this with either your surgeon or your primary care physician.
Many patients find that taking narcotic medications, as directed, helps to maintain their pain control. Be sure to always take your pain medication with food to help avoid nausea.
It is important to know that "no pain, no gain" is not our philosophy. tolerable discomfort is our goal, whether during exercise, daily activities, or at rest.
Be aware that pain medications often do cause constipation. Drink plenty of fluids, eat lots of fruits, vegetables and foods high in fiber (whole grains, cereals, etc.) to avoid constipation. Also, take your stool softeners as directed in the discharge summary sheet you will receive before leaving the hospital.
Refilling your pain medication
It is very important to call the clinic three to four days before you will run out of your medicine(s). Calling ahead is necessary because prescriptions for narcotic pain medications must be mailed to you or your pharmacy. By law, they cannot be called in to the pharmacy.
Wearing the stockings
You are still at risk for a blood clot even six weeks after surgery, so it is very important that you keep wearing your compression stockings 24 hours a day, 7 days a week. Your surgeon will tell you when you can take them off at your first follow-up appointment.
Your first follow-up appointment
Your first check-up will happen four to six weeks after your surgery. The exact time and date of your appointment will be noted on your discharge summary sheet. This appointment will include X-rays.
We urge you to contact us if you:
- Experience any unusual calf pain, redness, or swelling.
- Have a fever (temperature above 100.3) lasting longer than 24 hours. Note that mild temperature elevations are normal in the afternoons and evenings.
- Experience increasing redness, swelling, warmth, unpleasant odor or milky liquid coming from the wound.
- Experience increasing knee pain either with walking or at rest.
- Have a sudden shortness of breath or chest pain.
- Have trouble re-establishing normal bowel habits despite use of stool softeners and increased fluids.
- Have other symptoms you are concerned about.
- If you were discharged from the hospital to a rehabilitation or skilled nursing facility, please call your surgeon's nurse within 24 hours of returning home so she can discuss follow-up care with you. For phone numbers, please see the Joint Replacement Team Phone Directory.
How you will feel after the first six to eight weeks
It is not uncommon to feel frustrated even at six to eight weeks after surgery. You might think you are going a bit stir-crazy. You will get better. Healing takes time so be patient with yourself.
It is normal to experience an emotional slump about three weeks after surgery. It is difficult to be confined to your house when you've been used to being on the go when you like. This slump will pass. Feel free to call your surgeon's nurse for support - a little reassurance may be just what you need.
Many patients find that they still become tired very easily or are tired most of the time. Some patients find this is true for even longer than that (up to several months after surgery). These feelings are a normal part of your body's recovery from surgery and the healing that you have to do. Over time, as you are able to move more and have less pain, you may find that you are more tired instead of less. Allow time for an afternoon nap even when you have never needed one before.
Resuming regular exercise
Discuss regular exercise with your surgeon before doing anything other than walking or your physical therapy. Doing too much activity too soon can cause damage to your new joint(s) that you may not feel right away. However, use your operative leg as normally as possible, within the weight-bearing limit your doctor gives you. Try to fully extend your knee as often as possible.
Weight-bearing restrictions
Some surgeons will restrict the amount of weight you put on your operated leg for a period of time after your surgery. Please refer to your discharge summary for your personal surgeon's advice. It is important that you follow your doctor's and physical therapists's instructions. After looking at the x-rays at your first follow-up appointment, your surgeon may adjust the restrictions. The majority of knee replacement patiens are allowed weight-bearing as tolerated (WBAT) with an assistive device such as a walker or crutches. Follow the instructions of your surgeon. Your specific weight-bearing precautions are in effect until your first post-operative appointment in fourt to six weeks.
Driving
Narcotics and unreliable muscles may impair your ability to drive safely. You should not drive until after your first follow-up appointment.
Knee precautions
Follow the individual knee precautions that are given to you when you are discharged. It is important to follow these instructions to avoid dislocation of your new joint(s). In particular:
- Do not squat like a baseball catcher
- Do not jump off or over things
- Do not sit on your heels (haunches)
Long-term precautions
- Tell all of your current and future doctors about your surgery—they need to know.
- For the first two years after your surgery, or if directed by your primary care provider, you will need to take antibiotics any time you have dental work. This will help to reduce the risk of developing an infection in your artificial joint. Your primary care physician or dentist can provide you with the prescription before dental appointments. It is preferred that you do not have any elective dental surgery or dental cleanings one week before your surgery and six months after your surgery. Always be sure to tell your dentist that you have an artificial joint and have taken the necessary antibiotics. See a list of guidelines in the back of this guidebook that you can share with your primary care provider or dentist.
- It is normal for some patients to feel a dull ache when the weather changes or if they spend time out in the cold.
Walking with a limp
A limp is normal and is usually due to muscle weakness. Follow your exercise program and you will improve over time. Understand that your progress will be gradual. To even out their walk, some patients find that using a cane on the non-operative side can be helpful. It is very important that you do not favor your operated leg.
Please remember that it takes many months to fully heal, so try to be patient. You will continue to see improvements even after 12 to 18 months.
Follow-up visits
Our team will schedule regular follow-up visits each time you come to see us. These appointments may be with your surgeon, one of our physician assistants, or our nurse practitioner. These associate providers know your medical history and individual situation as well as your surgeon, so please feel confident that they will provide you with excellent care.
You can expect to come back for follow-up visits at these intervals:
- Post-Surgery
- 4-6 weeks
- 3-5 months
- 6-8 months
- Ongoing Care
- Every 1-2 years, for life
It is important to attend the ongoing care appointments every 1-2 years to be sure your joint replacement is performing properly. By conducting a regular physical exam and a review of x-rays, your care team can identify any problems that may be developing even though you may not have any physical symptoms.
