Orthopedics

Joint Replacement Institute

Spine

Knee Replacement FAQ's

What is the recovery time?

Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for one month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This usually takes about three months but can take longer.

When will my stitches be removed?

Approximately 10 to 14 days postoperatively. This may be done by a visiting nurse (if you are at home) or rehabilitation staff (if you are at a rehab facility). Some surgeons use stitches that dissolve and do not need to be removed. Your surgeon and nurse will instruct you in this. If your surgeon used nonabsorbable sutures, they are usually removed by a visiting nurse, at your surgeon's office or by a local physician 10 to 14 days after surgery.

How long do I need to keep a bandage on my incision?

Approximately one week or until there is no drainage from the incision. This should be changed daily to a new, dry sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation (clothing, compression stockings, etc.).

When should I wear a knee immobilizer? When can I discontinue it?

If your physician orders a knee immobilizer, it should be worn when sleeping and walking, until you are able to independently perform a straight leg raise. Most patients only use this for about one week postoperatively. However, if you wish to wear it for comfort, you may also use it at night for several weeks.

When can I shower (get the incision wet)?

Five days after your operation, if no drainage is present at the incision. (Initially, try to keep the incision dry with plastic wrap.) If it gets wet, pat it dry.

When can I immerse my knee in water (e.g., bath, swimming pool, ocean, hot tub)?

Typically, you should not swim or get in a hot tub for six weeks. However, some surgeons allow their patients to do so after two weeks if there is no drainage. Check with your surgeon.

How long will I be on pain medication?

You will likely require some form of pain medication for about three months. Initially, you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off their strong pain medication after one month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g., aspirin, ibuprofen, Anvil, Motrin, Aleve, Naprosyn) without first consulting with your internist.

Will I go to a rehabilitation facility or home?

It depends. Most people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to return home safely. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, postoperative functional status as evaluated by a physical therapist in the hospital and overall evaluation by our hospital team.

Do I need a physical therapist?

Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually two to three times a week). Sometimes you will be referred to an outpatient physical therapist. If you go to a rehabilitation facility, you will receive therapy there. Your therapist will keep your surgeon informed of your progress.

How often should I use a CPM (continuous passive motion) machine? What settings should I use?

If you have been given a CPM, you will use it about six hours per day. This may be divided any way you wish. For example, you can use it three times a day for two hours. The setting for flexion (bending the knee) can be increased daily as tolerated. Your surgeon and therapist will inform you how to set the machine upon your discharge from the hospital.

What exercises should I do?

You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and stationary bicycles are good exercise options. These should be continued indefinitely even after your recovery is complete. Do not begin using a stationary bike or swimming until four weeks after your surgery or until you have been seen by your surgeon.

What are good positions for my knee? what positions should I avoid?

You should spend some time each day working on strengthening your knee (extension) as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you're lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or a towel roll behind the knee for any length of time.

Can I use weights?

Generally not for the first two months. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with and gradually progress from 1 pound to a minimum of 5 pounds.

How long will I be on a blood thinner?

Typically, you will be on Coumadin (warfarin) as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a dose of Coumadin the night before surgery and continue you on Coumadin while in the hospital. You might stay on Coumadin for four to six weeks or switch over to aspirin. This will be decided prior to your discharge from the hospital. If you are on aspirin, you will be on this for 12 weeks. You may want to consider talking to your internist about the benefits of continuing aspirin after 12 weeks.

How long should I take iron supplements?

Four weeks is usually sufficient. These supplements help your body replenish its iron stores, which may be depleted postoperatively.

I am constipated. What should I do?

It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.

When can I drive?

If you had surgery on your right knee, you should not drive for at least one month. After one month, you may return to driving as soon as you feel comfortable. If you had surgery on your left knee, you may return to driving as soon as you feel comfortable as long as you have an automatic transmission. DO NOT DRIVE IF TAKING NARCOTICS! Some surgeons do not allow their patients to drive until they have seen them back in their office four to six weeks after surgery. Check with your surgeon.

When can I return to work?

This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately one month. If your work is more rigorous, you may require up to three months before you can return to full duty. In some cases, more time may be necessary.

When can I travel?

You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.

Will I set off machines at airport security? Do I need a doctor's note about my surgery?

You may set off the machines at airport security depending on the type of knee implant you have and the sensitivity of the security checkpoint equipment. At your follow up visit, you may ask to have a wallet card to carry with you for travel.

What activities are permitted following surgery?

You may return to most activities as tolerated, including walking, gardening, golf and doubles tennis. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.

What activities should I avoid?

You should avoid impact activities such as running, downhill skiing on expert slopes and vigorous racquet sports, such as singles tennis or squash. Some surgeons allow more vigorous activities. Check with your surgeon.

Can I have sex?

Yes, as soon as you feel comfortable.

Can I drink alcohol?

If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should avoid taking narcotics or other medications.

How long should I use compression stockings (TEDs)?

These should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat. Once the initial swelling has decreased, you may use ice or heat. Check with your surgeon.

Can I go up and down stairs?

Initially during your recovery period, leading up with the good (non operated) leg and down with the bad (operative side) is the preferred method for negotiating steps. After a few months, alternating steps will help strengthen both sides.

Can I kneel?

After about two months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets. You may find it more comfortable to use a kneeling pad.

Should I use ice or heat?

Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat once the initial swelling has decreased. Check with your surgeon.

What should I expect for my range of motion at six weeks? At one year?

Everyone's range of motion varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have at least 90 degrees of flexion and full extension by six weeks. At one year, you may have up to 125 degrees of flexion, but 105 to 110 degrees is usually satisfactory.

How much range of motion do I need?

Most people require 70 degrees of flexion (bending the knee) to walk on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs and 105 degrees to get out of a low chair. You should also come to within 10 degrees of being fully straight to function well.

I think my leg feels longer now. Is this possible?

For the large majority of cases, your leg length will be essentially unchanged. In rare cases, however, you may notice a change in leg length. This is more common when a severe deformity of the knee exists before surgery. At first, this may feel awkward. However, you will gradually become accustomed to your new knee and length. Occasionally, a shoe may be prescribed for you.

Do I need antibiotics before dental work or an invasive procedure?

Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or non urgent procedures for six weeks postoperatively.

I feel depressed. Is this normal?

It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.

I have insomnia. Is this normal? What can I do about it?

This is a very common complaint following knee replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed to you.

How long will my total knee replacement last?

This varies from patient to patient. For each year following your knee replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate.

When do I need to follow up with my surgeon?

Follow-up appointments should be made postoperatively at four to six weeks, one year, two years, five years, seven years and 10 years.

Normal things about your new knee:

  • Clicking noise with knee motion
  • Skin numbness on the outer (lateral) part of your knee
  • Swelling around knee or lower leg
  • Warmth around knee
  • "Pins and needles" feeling at or near your incision
  • Dark or red incision line
  • Increased bruising if on Coumadin
  • Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.

Abnormal things about your new knee (call the surgeon if you experience any of these):

  • Increasing redness, particularly spreading from incision
  • Increasing pain and swelling
  • Fevers (above 101 degrees)
  • Persistent drainage from your wound
  • Calf swelling or pain, particularly associated with ankle motion
  • Ankle swelling that does not resolve or decrease overnight
  • Bleeding gums or blood in urine/stool

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Joint Replacement Institute

925.416.3559

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