After Knee Replacement
Knee replacement is a surgery performed to replace parts of a diseased knee joint with an artificial prosthesis. The goal of knee replacement is to eliminate pain and return you to your normal activities. You can help in recovery and improve the outcomes of the procedure by following the instructions given to you at the time of discharge and referring to the information below to help guide your healing.
Postoperative pain is one of the most common causes of anxiety for patients undergoing knee replacement surgery. While recent advances in anesthesia techniques, multimodal pain protocols, and soft tissue sparing surgery have helped reduce the pain experienced after surgery, pain cannot be completely eliminated. There are many strategies to reduce pain following surgery including cold (ice) therapy, elevation, breathing exercises, and medications. Medications include narcotic pain relievers (oxycodone, hydrocodone, tramadol), acetaminophen (Tylenol), and anti-inflammatories (Celebrex, Motrin, Advil). It is important to keep in mind that narcotic pain relievers can improve pain, but it is unrealistic to expect complete elimination of pain. Efforts should be made to utilize pain management techniques that reduce the need to take these strong pain pills.
Hospital stay following knee replacement varies depending on your individual health, conditioning, and mobility. The average length of stay is 1-3 days with most patients safe to return home within 2 days. Outpatient knee replacement performed in a specialized surgery center is an option for healthy, motivated patients who wish to return directly home within 23 hours of surgery or even the day of surgery. Speak with your surgeon regarding what options are available to you.
Rehabilitation begins within 24 hours of surgery, where a physical therapist will help you stand up and walk using crutches or a walker. Adhering to the goals of the rehabilitation program is important to help you recover and resume your normal activities. You will be guided to perform strengthening exercises daily and learn to get in and out of bed, and use a bedside commode. When you are discharged from the hospital, you will be encouraged to walk short distances with an assistive device, climb a few stairs, dress, bathe and perform other basic functions by yourself.
The overwhelming majority of patients can be discharged directly home after surgery. While in the past patients were often sent to an inpatient rehabilitation or nursing center after surgery, multiple studies have shown that patients are safe returning home immediately upon discharge, even if they live alone. In addition, some studies have shown higher complication and re-admission rates for patients who go to an inpatient rehab center from the hospital. Patients sent directly home have the option of receiving home nursing and physical therapy care in the weeks following surgery which can help to aid your transition. Discuss concerns about your immediate postoperative recovery with your surgeon.
On reaching home, have a family member or caregiver assist you with your activities for a few weeks. Taking care of someone following knee replacement surgery requires compassion, awareness and patience. Basic points to follow by your caregiver:
Helping with basic movement and functions as well as emotional support
Having a clear understanding of your medication and ensuring they are administered in a timely manner
Keeping emergency numbers ready
Assisting you with household chores, paperwork and traveling to keep your appointments
Helping and motivating you to perform your rehabilitation exercises
Ensuring that furniture is rearranged so as not to interfere with your movement and cause falls.
To avoid bending or reaching out, items that you use frequently can be placed easily within reach.
Certain instructions that your doctor will brief you about are:
- You may shower right away but avoid soaking in a bathtub for at least six weeks.
- Keep the wound clean and dry. Your doctor will let you know when you can shower or bathe.
- Some amount of swelling is normal after knee replacement and may last for more than a month. It can be controlled by icing and elevating your leg for 30 to 60 minutes every day.
By week 3, you should be able to move with minimal assistance and significant reduction in pain. Your physical therapy program will gradually include new and more difficult exercises as you improve in strength and flexibility. By week 7, you should be able to walk independently. To reduce stress, use the opposite knee to lead when climbing stairs and the replaced knee to lead when descending. You will be able to drive a few weeks after surgery when you have sufficient pain control, improved strength and can easily enter and exit a car. Walking and exercising at least 2-3 times a day for 10-15 minutes is recommended for a faster recovery.
You and your caregiver must be aware of the signs of infection. Contact your doctor if you notice any abnormal wound changes or any changes in general health and mental state, or should you have persistent fever, drainage, excessive swelling or other signs of infection. We strongly advise against seeking care in the emergency department, and urgent care center, or with your primary care doctor for issues regarding postoperative recovery without contacting your surgeon unless you feel your condition is life threatening.